HEALTH CARE RESEARCH COLLABORATIVE

Resilient Flooring & Chemical Hazards A Comparative Analysis of Vinyl and Other Alternatives for Health Care

APRIL 2009

AUTHORS: Tom Lent, Julie Silas, and Jim Vallette Health Care Without Harm has initiated a research collaborative coordinated by faculty of the University of Illinois at Chicago School of Public Health, with support from the Pioneer Portfolio of the Robert Wood Johnson Foundation aimed at stimulating collaborative research around health and safety improvements in health care. This collaborative is designed to increase the evidence base concerning the human health and environmental impacts of materials, products and practices within health care. In partnership with the Global Health and Safety Initiative (GHSI), the Research Collaborative is engaged in research directed at the intersection of environmental, patient, and worker safety issues related to building and operating health care institutions.

This paper is part of series in which the Collaborative will provide research and analysis of the health and environmental impacts of select groups of this new generation of materials and facilitate sharing of experiences on installation, maintenance and performance. TABLE OF CONTENTS

Acknowledgements ...... 2

Executive Summary ...... 3

I. Introduction ...... 6

II. Description of the Analysis ...... 7 Principles ...... 7 Priority issues for chemical policy ...... 8

III. Assessing Individual Materials ...... 14 A. Vinyl flooring ...... 14 B. Rubber flooring ...... 18 C. Polyolefin flooring ...... 24 D. Linoleum flooring ...... 27

IV. Summary: Comparisons and recommendations on chemical hazard and closed-loop characteristics ...... 31

V. Conclusion and Future Research ...... 36

Appendix A: Review of Other Comparative Studies ...... 38

Appendix B: Chemical Hazard Lists ...... 40

Appendix C: PVC and Dioxin ...... 44

Appendix D: Composition of Stratica ...... 45

List of References ...... 46 Acknowledgements

Healthy Building Network would like to thank the following people who helped in the development or review of Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care: Richard Bass, Tom Cooper, Stephen Dempsey, Jennifer Dubose, Dawn Fredrick-Seibert, Kathy Gerwig, Derek Goins, Robin Guenther, Jason Harper, Rachel Machi, Ron Miller, Hubert Murray, Joe O’Farrell, Peter Orris, Mark Rossi, Ted Schettler, Karen Vegas, and Chris Youssef.

This paper was generously funded from the Pioneer Portfolio of the Robert Wood Johnson Foundation.

Design & Layout by Kieran Daly & Parisa Damian of Winking Fish. EXECUTIVE SUMMARY

With the rapid growth of interest in green building, The framework utilizes authoritative chemical hazard innovative building products are entering the health lists to rank chemicals based upon the types of hazards care marketplace on a continuing basis. As health care that they present and the confidence levels of the facilities evaluate these materials for installation in new science behind the assessments, with priority focus on and renovated health care facilities, they are search- persistent bioaccumulative toxicants (PBTs) and car- ing for better information about the real impact these cinogens, mutagens or reproductive toxicants (CMRs). materials have on health and the environment. The authoritative hazard list approach in some cases is supplemented by reference to emerging science that In an effort to help address this need, Health Care has not yet been reflected in the lists. This paper also Without Harm (HCWH) has initiated a Research reviews the state of the use of recycled or biobased Collaborative coordinated by faculty of the University materials in resilient flooring products and their design of Illinois at Chicago School of Public Health, with for recycling or composting at the end of their useful support from the Pioneer Portfolio of the Robert Wood life and how that could reduce – or exacerbate – chem- Johnson Foundation. This collaborative is designed ical hazards. to increase the evidence base concerning the human health and environmental impacts of materials, prod- Patient and staff safety issues affected by performance ucts and practices within health care. In partnership of the products, such as slip-fall safety, are beyond the with the Global Health and Safety Initiative (GHSI), scope of this study but will be addressed in future studies the Research Collaborative is particularly interested in in this series. research directed at the intersection of environmental, patient, and worker safety issues related to building and All three of the petrochemical -based materials operating health care institutions. studied (vinyl, synthetic rubber & polyolefin) have a common heritage of problems with PBTs and CMRs Resilient Flooring & Chemical Hazards: A Comparative that are released from drilling and refining operations. Analysis of Vinyl and Other Alternatives for Health Care The analysis in this paper focuses on the issues that is the first in a series of papers in which the Collabora- distinguish them in manufacturing and beyond once tive will provide research and analysis of the health the petroleum has been extracted and refined. and environmental impacts of select groups of this new r Vinyl flooring (both sheet and VCT) made from generation of materials and facilitate sharing of experi- (PVC) has the most pervasive ences on installation, maintenance and performance. presence of unavoidable persistent bioaccumulative toxicants (PBTs) in its life cycle of the four exam- Resilient Flooring & Chemical Hazards: A Comparative ined materials. It earns worst in class status due to Analysis of Vinyl and Other Alternatives for Health Care its dioxin by-products and several other PBTs of addresses resilient flooring, evaluating potential health concern. Vinyl also has significant user and manu- impacts of vinyl flooring and the leading alternatives – facturing exposure issues associated with chemical synthetic rubber, polyolefin and linoleum — currently additives used in manufacture, including , in the health care marketplace. The study inventories heavy metals, and other and reproduc- chemicals incorporated as contents in each of the four tive and developmental toxicants that are required material types or involved in their life cycle as feed- for its performance characteristics. stocks, intermediary chemicals, or emissions. It then characterizes those chemicals using a chemical hazard- r Synthetic rubber flooring is an improvement over based framework that addresses: PVC but still heavily laden with hazards. Like PVC, r persistence & bioaccumulation; its manufacture includes a substantial amount of r human toxicity; and PBTs, but there is more potential to remove PBTs through reformulation than is achievable with PVC. r human exposure.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 3 Still, the primary compound used in synthetic rub- It is important to note that in each category, manufac- ber – styrene butadiene – is dependent upon two turers produce products which meet the most stringent feedstocks, leaving it also with unavoid- current indoor air quality standards, but still present able serious High Hazard chemicals in its life cycle. some potential user exposure problems. This is because Rubber flooring materials trigger concerns with toxic the standards do not cover many of the compounds contaminants in the manufacturing process, as well discussed here and the VOCs they do measure may as in the final product, including the use of hazard- be individually present in levels below the standard ous flame retardants. Use of recycled rubber flooring thresholds but still may be problematic in combination. may also raise concern because of its potentially high toxic content. There are significant differences in the recycled content used in products with the materials studied, r Polyolefins appear to be a more significant but virtually none of the products contain significant improvement over PVC in relative hazard. The quantities of post-consumer content. Furthermore, the specific product we studied has only one with one products with the most recycled or biobased content known PBT problem with a potential decomposition today still have significant toxic issues associated with product (other than those associated with petroleum those processes. There is plenty of need for specifiers refining). The only known user exposure issues were and purchasers to encourage manufacturers to increase low level VOC issues (shared by the other materi- use of renewable materials that are free of PBTs and als.) An important caveat to the analysis, however, CMRs and to design for end of life recycling or com- is that research into the polyolefin material was posting. None of the resilient flooring manufacturers somewhat hampered by the lack of emissions release utilizing the materials reviewed are close to closing the data normally available in the U.S. Analysis of loop of material flow through recycling or compost- available information about manufacturing processes ing for a significant percentage of their production. In uncovered only one carcinogen (formaldehyde), this area there are however, also significant differences which may be eliminated through reformulation. between the materials, both in current practice and The most significant integral hazard identified in future potential. association with polyolefins, is the possibility that ethylene – a major feedstock for all of the petroleum All of the material types have demonstrated the based flooring types – may be metabolized into a potential to be recycled (or in the case of linoleum, carcinogen and reproductive toxicant. composted), but all face similar challenges in dealing r Linoleum, the only material reviewed containing with the adhesives used for securing the product to the biobased content, receives relatively good marks floor and in collecting and transporting product at the for both current hazard and potential for further end of its life back to the manufacturing facilities. All improvement. The linoleum life cycle has potential of the petrochemical materials also have the inher- PBT problems from the pesticides used in growing ent limitation that, due to wide variation in chemical the flax feedstock. Some manufacturers are already composition of additives, they cannot be mixed for working to eliminate these by encouraging organic recycling with other materials even of the same plastic farming techniques. Linoleum has had some signifi- type, except for downcycling into lower grade products. cant user exposure problems with VOCs, but manu- Linoleum may have the highest potential here since it facturers are learning to manage those challenges can be composted with other materials if the adhesive through product redesign. Some linoleum feedstock issue can be resolved. materials are manufactured with High Concern process chemicals. However, none of these are Resilient Flooring & Chemical Hazards: A Comparative integral to linoleum’s performance and there appear Analysis of Vinyl and Other Alternatives for Health Care to be reformulation or redesign options that permit indicates that, as currently produced, no resilient floor- elimination of each problematic chemical. Because ing option commonly used in health care is perfectly most of the linoleum used in the U.S. is manufac- hazard free. The material types vary considerably in the tured overseas, limited information was available on amount, extent, and exposure to PBTs and other chem- manufacturing process emissions. icals of concern that are involved in each material’s life cycle and in the potential for future improvement.

4 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care There are many opportunities for specifiers and Many health care systems, including those profiled purchasers to encourage manufacturers to reduce or in this study, are effectively specifying and using the eliminate the use and production of PBTs and chemi- alternative materials in new and renovated health care cals of High Concern, primarily in the linoleum and facilities. Capturing and reporting on the experiences polyolefin alternatives. With encouragement from the facilities have with these new materials and broadly marketplace, some resilient flooring manufacturers can sharing this information may assist in both wider adop- readily reformulate their products to virtually eliminate tion and product innovation. the PBTs and CMRs from manufacture, use and dis- posal. Specifiers and purchasers can also call for greater With greater awareness of the health issues associated use of renewable feedstock materials and recycling or with the materials in resilient flooring products and improved end of life management. the products required to install and maintain them, health care organizations and designers can make more While no ideal “green” material currently exists for informed decisions and collectively help move the health care flooring options,Resilient Flooring & Chemi- market by their specifications and purchasing power. In cal Hazards: A Comparative Analysis of Vinyl and Other turn this can reduce the hazardous chemicals intro- Alternatives for Health Care illustrates the existence of duced into interior environments by the building mate- a range of alternative materials which are preferable rials and promote a healthier healing environment. to sheet and tile products made with PVC – posing fewer chemical hazards in their current formulations and having more potential for further improvement. Yet, hundreds of health care organizations continue to source PVC-based products for their facilities. Lack of information about performance, lack of experience in cleaning and maintenance, and the slow pace of change in the health care industry all contribute to slowing the transformation of the industry to source safer alternatives.

Future papers are anticipated in this series to address resilient flooring product cost, durability and perfor- mance issues, acoustics, installation and maintenance chemicals (adhesives, sealants, other post-installation finishes, and cleaning chemicals) and other patient/ staff health and safety issues affected by physical performance, rather than by chemical content, such as glare, fatigue, traction and slip-fall injuries. Likewise, this analysis will be extended to other flooring prod- uct types, including more newly developed synthetic -based materials and other traditional materials such as terrazzo and cork.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 5 IINTRODUCTION.

Resilient flooring is a popular choice for floor cover- ing products. It uses the framework to comparatively ing in health care facilities, due to durability, ease of assess the materials most frequently used in health cleaning and routine maintenance, low cost, comfort, care flooring products today. The framework addresses and the broad range of available designs. Resilient chemical hazard based upon three sets of character- flooring manufacturers use a range of feedstock materi- istics: persistence & bioaccumulation, human toxic- als to make their products: from synthetic petrochem- ity, and exposure. The paper focuses on the chemical ical-based polymers including vinyl, rubber and poly- hazards in the life cycle of the flooring materials from olefin, to natural materials such as natural rubber and production, to user exposure, to end of life (hazards linoleum. The products come in roll, tile and plank from associated installation and cleaning products will forms. Until the 1950s, resilient flooring was primar- be addressed in a future paper). This study also reviews ily made from linoleum (typically comprised of wood the state of the use of recycled or biobased materi- flour, linseed oil, and rosin). Technological improve- als in these products and their design for recycling or ments, coupled with falling petrochemical prices, composting at the end of their useful life and how that drove the rapid adoption of vinyl floors in the 1960s, could reduce – or exacerbate – chemical hazards. replacing linoleum as the predominant resilient floor covering in health care applications. As petrochemi- This paper compares three widely used resilient flooring cal products gained market prevalence, more durable product material types to PVC-based sheet vinyl: rub- wax coatings were developed to improve wearability ber (primarily styrene butadiene rubber or SBR), one of and appearance in high traffic areas. By 1970, vinyl the new polyolefins (Amtico’s Stratica), and linoleum. sheet and tile flooring products, maintained through In the appendix, it surveys other comparative studies of rigorous wax and strip protocols, were unchallenged these flooring types, which have included assessments in health care interiors. Moreover, vinyl was marketed of health impacts. Finally, it includes case studies from and positioned as a “modern material,” an appropriate four health care systems that have installed three of the choice for the emerging technologically sophisticated alternative material types. hospital building. Future papers are anticipated in this series to address Two important design trends have coalesced to open cost and performance issues, installation and mainte- up new markets for alternative resilient materials: nance chemicals (adhesives and sealants, post-installa- an interest in products and materials that connect tion finishes, and cleaning chemicals) and patient/staff building occupants to nature in health care settings, health and safety issues affected by performance of the and concerns over potential negative health impacts products rather than chemical content, such as glare, linked to the polyvinyl chloride (PVC) in vinyl sheet fatigue, traction and slip-fall injuries. We also intend and vinyl composite tile (VCT) flooring products. As to study other flooring product types, including more a result, the market has developed new products and newly developed synthetic polyethylene-based materi- reintroduced older traditional ones. While scientists als and other traditional materials such as terrazzo, and have scrutinized PVC and continue to identify the cork. Although generally not considered appropri- health issues associated with the material, researchers ate for hospitals, these materials are beginning to be have paid much less attention to the presumed “health- specified in medical office buildings (MOBs) and other ier” alternatives. health care facilities with less demanding requirements.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care defines a chemical hazard-based framework to assess health impacts associated with materials used in build-

6 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care DESCRIPTION IIOF THE. ANALYSIS Resilient Flooring & Chemical Hazards: A Comparative ones. The U.S. Environmental Protection Agency’s Analysis of Vinyl and Other Alternatives for Health Care (EPA) Prevention Act of 1990 places pollu- addresses impacts of materials tion prevention – that is, avoiding the processes that through a hazard-based analysis. In the analysis, we iden- create pollution – as a higher priority than efforts to tify chemicals associated with the material throughout its capture and store or treat pollution.2 life cycle: those that are used in each stage of manufactur- ing, those present in the final product, and those emitted The process of managing hazard is frequently challenged during use or at the end of the life of the product. by the lack of complete health and ecological toxicity information on the bulk of chemicals currently in com- merce. Furthermore, available information may be con- flicting. Scientists address this uncertainty by evaluating Principles the “Weight of the Evidence” to seek patterns indicat- ing likely outcomes. The hazard analysis is grounded in a series of related principles: These uncertainties are then addressed in the policy arena by application of the Precautionary Principle, The Hierarchy of Controls is a generally recognized set which encourages “precautionary measures … when an of principles for addressing hazards developed in occu- activity raises threats of harm to the environment or pational health studies that places elimination of hazard human health, even if some cause and effect relation- above management and protection. The hierarchy can ships are not fully established scientifically.”3 be represented as: r Elimination Finally the principle of designing for a Closed-Loop r Substitution System – also referred to as a “cradle-to-cradle” process – has long been considered important for slowing the r Engineering controls depletion of global resources and reducing waste. At Administrative controls r the end of life of a product in a closed-loop or cradle- r Personal protective equipment to-cradle process, all of the material used in a product is cycled back – either through reuse, recycling or Elimination and substitution are inherently safer and composting – to provide the material inputs to make hence the most effective at reducing hazard, while the same product or one of equal performance and administrative controls and protective equipment are value.4 This principle can have significant implications the least effective and most prone to failure through for chemical hazard as well as for waste and resource human error. Additionally, while frequently cheaper in depletion. Highly toxic, and in some cases persistent the short run, controls and protective equipment tend bioaccumulative chemicals, are associated with the to be more expensive over time.1 extraction and refining of petrochemical materials and, for some materials, with their disposal as well. Closing The Pollution Prevention principle has applied this the loop can bypass the extraction and refining stage of same hierarchical approach to environmental damage the life cycle, as well as the disposal stage, and elimi- and public health, encouraging exploration of alterna- nate substantial chemical releases. tives and substituting hazardous chemicals with safer

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 7 Persistence & bioaccumulation Priority issues Persistent and bioaccumulative chemicals resist breaking down into more benign substances and tend for chemical policy to accumulate in increasingly higher concentrations as the chemicals get passed up the food chain to Chemical policy development under these principles humans (see box on “PBTs Creating Global Chal- has focused in recent decades on prioritizing vari- lenges”). Hazard reduction puts highest priority on ous chemicals of concern for substitution with safer elimination of the chemicals that are known to be chemicals. When applied to material assessment, this the most persistent and/or bioaccumulative. prioritization focuses on three different groups of char- acteristics to inform substitution efforts: r Persistence and bioaccumulation r Toxicity r Exposure

PBTs Creating Global Challenges

Persistent and bioaccumulative toxicants (PBTs) are and humans for prolonged periods of time. For particularly detrimental to human health and the example, PCBs have not been manufactured in the environment. “Persistent” means that they do not United States since the 1970s, yet detectable levels break down rapidly in the environment and can last of PCBs still remain in humans more than 30 years for months, even years, and sometimes decades.5 later.8 Twelve PBTs have been targeted for elimina- Once emitted, some PBTs can travel long distances tion by international treaty9 and more are subject from their origins through air and water. 6 7 to action by national and international bodies,10 the U.S. government11, and in segments of the health In addition to being persistent, PBTs bioaccumulate; care industry.12 The highest priority PBTs are those their concentrations build up in living organisms referred to as Persistent Organic Pollutants (POPs), and biomagnify as they move up the food chain. identified in the global Stockholm treaty.13 Many PBTs are stored in fatty tissue, increasing their concentrations by orders of magnitude as they move Halogenated organic compounds (containing a up the food chain to humans at the top, becoming halogen such as chlorine, bromine or fluorine at- most concentrated in mothers’ milk. tached to carbon) are frequently targeted for special examination and elimination because, members Lastly, but clearly of great concern to humans, is the of this class are often persistent, bioaccumulative, fact that PBTs are toxic. They can cause cancer, gene biologically available and can frequently lead to mutations, or impair normal development or repro- formation of high priority halogenated PBTs when duction, among other adverse effects. manufactured or burned.

Because PBTs are often released into the environ- ment and take long to degrade, significant concen- trations of these toxicants are often found in wildlife

8 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care Toxicity Resilient Flooring & Chemical Hazards: A Comparative Along with PBTs, government14 and health care policy Analysis of Vinyl and Other Alternatives for Health Care makers15 have prioritized avoidance of chemicals that inventories chemicals that are used or created in the life are known carcinogens, mutagens or developmental or cycle of the four materials commonly used in resilient reproductive toxicants (known as CMRs), including flooring. It then screens those inventoried chemi- developmental neurotoxicants (which affect the devel- cals against the authoritative chemical hazard lists in opment of the brain or nervous system). Endocrine Appendix B in order to identify which chemicals have disruptors (which disturb the functioning of the body’s been categorized as persistent bioaccumulative toxicants, endocrine system) are sometimes included in this top carcinogens, mutagens, reproductive toxicants, develop- priority category because of their potential for disrupt- mental toxicants, neurotoxicants and aquatic toxicants ing normal development with lifelong consequences. from these lists. Appendix B includes Table 4, a listing of Chemicals that cause other chronic or acute health chemicals discussed in this analysis and cross referenced effects, such as asthma, or are toxic to wildlife, often to the Appendix B authoritative lists upon which Table get next priority. Table 1 on the next page summarizes 4 is based. This list-based analysis is supplemented in these chemical hazard criteria and the ranking that is some cases by reference to emerging science that has not utilized in this paper. yet been reflected in the lists.

A wide range of governmental and non-governmental The screening and ranking shares elements of the organizations publish authoritative chemical hazard Green Screen for Safer Chemicals (Green Screen) lists. The assorted lists identify the types of hazards analytic framework developed by CPA. The Green that various chemicals present and the confidence Screen utilizes an authoritative list screening and rank- levels of the scientific data behind the assessments. ing procedure similar to that used in this paper. To the Examples of these include: the Stockholm Conven- quick scan list-based chemical assessment, the Green tion on Persistent Organic Pollutants (POPs); the U.S. Screen adds more detailed quantitative threshold-based EPA National Waste Minimization Program, Priority assessments of toxicity to create a hierarchy of prefer- Chemicals; the State of California’s Proposition 65 list ences for chemicals based upon their hazardous proper- 16 of Chemicals Known to the State to Cause Cancer or ties. It then looks at where the chemical is located Reproductive Toxicity; and the U.S. National Toxicol- in the product life cycle and the resulting potential ogy Program’s Report on Carcinogens. The Healthy population exposures to determine preference. The Building Network (HBN) and Clean Production Green Screen not only provides a system for avoidance Action (CPA) have collaborated together to develop of hazardous chemicals, but also provides an approach a hazard-based ranking of chemicals based upon these to identifying safer chemicals. authoritative lists and the criteria discussed above. The ranking is designed to facilitate scoring of materials Resilient Flooring & Chemical Hazards: A Comparative and prioritization of chemicals for substitution with Analysis of Vinyl and Other Alternatives for Health Care safer alternatives. Appendix B: Chemical Hazard Lists, focuses on the hazard end of the spectrum of prefer- identifies and references key authoritative lists and cat- able chemicals – identifying chemicals with known or egories used in this analysis and characterizes them on suspected hazardous characteristics. As more chemicals a ranking from moderate concern to very high concern. are assessed against the Green Screen and tools like it, it will be possible to focus more on the preferable end of the spectrum, identifying truly safer chemicals that can be placed in the green Low Concern category, as identified in Table 1.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 9 Table 1: Criteria for prioritizing chemicals based on persistence, bioaccumulation, health endpoints and confidence in the science

Very High Persistent Organic Pollutants (POPs) targeted in the Stockholm POPs treaty Highest priority Concern and other Persistent Bioaccumulative Toxicants (PBTs)* to eliminate

High Concern Known or likely carcinogens, mutagens, reproductive toxicants, developmental toxicants or endocrine disruptors.

Moderate Significant possibility of above hazards but lower confidence or known or likely Concern neurotoxicants, respiratory sensitizers or leading to other chronic human or ecotoxicity endpoints. Caution Moderate concern for any of the above health endpoints or preliminary Use with caution. indications of higher concern but with inadequate test data or acute human Avoid where health concern possible Low Concern Tested with low concern for any of the above endpoints**

Prefer

See Appendix B for explanation of criteria and how various chemical lists are ranked by these criteria. * includes chemicals which are very persistent and bioaccumulative but toxicity is unknown. ** This paper reports on the chemicals that fall in the Moderate to Very High categories, not Caution or Low. Few authoritative lists yet identify chemicals for “Low” categorization.

Exposure r Manufacturing exposures – worker and community: The ultimate goal of this analysis is to encourage the Every product has feedstocks and intermediaries development of products made from materials that uti- – the chemicals used in the manufacturing pro- lize chemicals lowest on the hazard spectrum considering cess to make the final product contents – that do usage and exposures at all stages of the product life cycle: not appear on a product content list and may not directly affect users of the product, but may be High r Persistent exposures: Materials that result in the Concern chemicals and can pose serious hazards release of PBTs to the environment from anywhere to workers and plant neighbors. Government and in the product life cycle – from the raw material advocates have made great strides to improve extraction and refining, to the factory, to use, to occupational safety in the U.S. and companies have the landfill – rank as “Very High Concern” in this instituted more technological and administrative framework because these PBT chemicals persist for control systems, but workers are still exposed to long periods of time and so may continue to expose many highly toxic chemicals that could be elimi- people in the vicinity long after their release. In nated through substitution of safer chemicals. Like- some cases they can spread to affect people and wild- wise, despite grassroots community efforts to push life over large distances, sometimes even globally. manufacturers to reduce releases, millions of tons r User exposures: Materials that contain toxic of toxic chemicals are still released every year into 17 chemicals in their contents are of major concern neighboring communities – often minority com- because they expose installers and the occupants munities already suffering health disparities without of the buildings in which they are installed to the the added effects of unnecessary toxic releases into 18 chemicals’ hazards associated with them. Products their yards, water, and air. such as resilient flooring, which line the interiors of buildings, are of particular concern because Some of the process chemicals that are supposed of the large surface areas to which occupants are to be contained or completely transformed or continuously exposed. eliminated in the manufacturing process (such as

10 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care monomers, catalysts or cleaning agents) can instead r Will patients and/or staff be exposed to hazardous unintentionally remain in the final product. The chemicals during routine maintenance and cleaning chemicals are residual and can result in exposures of the product? for users of the final product as well. Some of these r Have biomonitoring studies shown that the hazard- chemicals may “off-gas” during or following instal- ous chemicals associated with the product are in our lation as volatile organic compounds (VOCs). Most breast milk, blood, or urine? Have OSHA or other major manufacturers of flooring materials for the regulatory bodies set threshold limits or warnings for health care industry provide products that have occupational exposure to chemicals involved in the passed any one of a number of independent indoor manufacturing of the product? air quality (IAQ) certifications to validate that they have addressed IAQ impacts by designing the prod- r Are the manufacturing facilities releasing toxic uct for reduced VOC emissions (see box on “VOC chemicals into surrounding communities through air Testing: Only Part of the User Exposure Story”). or water? r Raw material extraction & refining: All three of These are only a few of the questions that may be the petrochemical plastic-based materials stud- considered when evaluating and weighing exposure ied in this paper (PVC, SBR & polyolefin) have concerns. a common heritage of problems with PBTs that are released from drilling and refining operations. Drilling for the oil and gas from which are Closing the Loop made releases heavy metals, including cadmium and Most of the resilient flooring products reviewed here mercury, and a host of other high hazard chemicals use materials manufactured from petrochemicals, such as furans, xylene, arsenic, chlorophenols, and installed in a building for a single use, and then finally polycyclic aromatic hydrocarbons into the environ- disposed of in an incinerator or landfill at the end of ment. The hazardous releases continue at petroleum the product’s useful life. Extracting fossil fuels from refineries, which emit lead, naphthalene, benzo(a) the ground is a process that results in release of a wide pyrene, and other toxic chemicals. This analy- range of toxic materials, including PBTs, as noted sis does not address that stage of the life cycle of above. The refining process common to all petrochem- petrochemical plastics, as it is common to all of the ical materials is also burdened with a wide range of plastics studied and so is not a distinguishing factor. toxic chemicals. Then if the flooring product is incin- Instead, the paper focuses on the issues that distin- erated, it may release more toxic chemicals as gaseous guish the petrochemical plastics in manufacturing emissions in the burning process and as and beyond. As biobased products are credited with in the fly ash that remains after the burn. Depositing positive value by avoiding the toxic releases of the the product in a landfill is also problematic, as chemi- petrochemical extraction stage, however, the study cals from the product can leach into groundwater or does note the potential for chemical releases in the materials may burn in highly polluting and relatively production of biobased raw materials. common landfill fires.

In assessing alternative materials for health care Manufacturers reduce the hazards in a product’s life applications, it may be helpful to think about some of cycle by “closing the loop” – designing for manufacture the key exposure issues that are relevant to decision from recycled materials and disposal through recycling making, including the list below. Given the wide vari- back into new feedstock at the end of its life. This ety of health care settings and applications of resilient turns the one-way path of extraction, manufacture, use flooring, it is important to recognize the distinctive and and disposal, into a continuous loop of reuse. Using relevant characteristics: recycled materials in a product can bypasses the toxic (and energy consuming) extraction and refining process r Will patients and/or staff be exposed to the chemi- needed to make new materials from virgin ores or fossil cals released from the product during use? Are staff fuels. Recycling the product at the end of its life avoids or patients potentially exposed to the chemicals generating waste and eliminates the toxic chemical during installation of the product? Can the risk of releases at the incinerator or dump. exposure be mitigated or eliminated?

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 11 VOC Testing: Only Part of the User Exposure Story

Several certification programs address the indoor air addressed by any VOC emission program to date: quality (IAQ) impacts of resilient flooring products, t 5IF4UBUFPG$BMJGPSOJBIBTPOMZFTUBCMJTIFESFGFS- including FloorScore,19 GreenGuard20 and the Collab- ence levels for 80 VOCs. Hundreds more VOCs are orative for High Performance Schools (CHPS).21 Each not addressed; of these addresses the emissions of volatile organic t 5IFSFGFSFODFMFWFMTUIF4UBUFPG$BMJGPSOJBFTUBC- compounds (VOCs) from flooring products and/or lished only address non-cancer issues and do not assemblies. necessarily provide protection against carcino- genic effects of these chemical emissions; VOCs are chemicals that can evaporate into a gas at t 5IFSFGFSFODFMFWFMTEPOPUBEESFTTUIFFòFDUTPG room temperature, such as toluene, acetaldehyde two chemicals in combination, which may have and formaldehyde. Many VOCs are toxic chemicals, synergistic effects far beyond the additive ones of some of which are listed on the chemical hazard lists the two VOCs individually; used in this paper. For example toluene is a listed 22 t 5IFUFTUTEPOPUNFBTVSFUIFFòFDUTPGTVOMJHIU  developmental toxicant. Researchers have impli- ozone or other chemicals that may increase or 23 cated them in sick building syndrome cases. The change the nature of emissions;25 certification programs noted above operate under a protocol that the State of California developed, t 5IFUFTUTPOMZNFBTVSFFNJTTJPOTPG70$T OPU SVOCs (semi-volatile organic compounds) such often referred to as Section 01350.24 The protocol as phthalates, perfluorinated compounds, and describes a methodology for measuring the emis- halogenated flame retardants, or heavy metals, sions from a sample of an interior finish product and like lead, that can migrate from the product by then using modeling to predict the concentrations direct user contact or by attaching to dust and of the detected chemicals that would accumulate transporting into the breathing space; and in a typical room or building using that product. To pass these tests, the modeled concentration needs t .VDIPGUIFTDJFODFCFIJOEUIFTFUUJOHPGUIFTF to be less than half of reference levels the State of standards is aimed at occupational exposures on California has set for 80 of these VOC chemicals. Most middle-aged healthy workers. Newborns, chil- of the major manufacturers of flooring products for dren, elderly and otherwise vulnerable popula- the health care industry provide products that have tions are not necessarily protected. passed one of the Section 01350-based certifications to validate that VOC emissions are at or below the Results from these certification programs should State reference levels. be accompanied by additional screening for hazard chemical content as outlined in this paper to be fully These programs provide important information protective of human health and to reduce or elimi- about indoor air quality and user exposure, but they nate exposures. also have several limitations. It is important to note that the particular test used in these certification programs is not a comprehensive test of all potential exposure issues. Several important issues about the full effects of user exposure to these products are not

12 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care It is important to note, however, that closed-loop r End of life: To close the loop, a product must be recycling processes are no guarantee of a lower hazard designed so that it is capable of being recycled back result and must be approached with caution and scru- into materials that can be used for similar grade tiny as toxic chemicals are sometimes used or released products. Most current resilient flooring recycling in the process of recycling. Another way material man- does not meet this standard. Instead most materi- ufacturers can close the loop is by utilizing biobased als are “downcycled” – recycled for use in a less materials and/or designing products to be composted demanding product. For example many carpet and back into nutrients for the agricultural cycle at the end resilient flooring recycling programs recycle the used of their life. material into things like traffic cones or, at best, into new carpet backing components. They continue to Resilient Flooring & Chemical Hazards: A Comparative use virgin materials to make new resilient flooring Analysis of Vinyl and Other Alternatives for Health Care products. addresses both ends of the product life cycle: r Renewable content: Most of the leading manufac- turers of the resilient flooring products reviewed claim to have developed processes to recycle their own production waste back into their manufacturing process. A smaller number have developed systems for using other manufacturers’ waste material – what is called post-industrial recycling. Waste material from manufacturing processes is important to utilize to improve the efficiency of the use of raw materials, but it does not close the loop. It does not eliminate the waste that comes from the final disposal of the product nor does it end the need to extract more virgin ores and fossil fuels for raw materials. Only by using post-consumer recycled material – material derived from products at the end of their useful life – is the loop closed and extraction replaced. There- fore, post-consumer content is valued more highly in this analysis.

Biobased material can also potentially reduce fossil fuel consumption, waste, and toxic chemical use and release. However, given the high dependence of modern agriculture on toxic chemicals and fossil fuels, the use of biobased materials does not neces- sarily reduce chemical hazards, unless steps are taken to improve the agricultural practices through which the feedstock is grown – i.e., by eliminating toxic pesticides, reducing fossil fuel energy use, and using soil conservation practices.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 13 ASSESSING INDIVIDUAL III MATERIALS. In the next sections, each material is assessed individu- ally – vinyl, rubber, polyolefins and linoleum. A. Vinyl flooring The investigation employs the analysis framework Polyvinyl chloride (PVC, often called vinyl*) is the described above. The evaluation process includes the primary component of vinyl sheet goods and is the following steps: inventory the chemicals involved in primary synthetic plastic ingredient in vinyl composi- the material’s life cycle, identify the hazards the associ- tion tile (VCT). The single largest component of VCT ated chemicals pose, assess the exposure pathways, (often 80% or more of total content) is limestone . identify opportunities to close the loop, and compare each of the alternatives to PVC. Table 2, on page 34, First discovered in the 19th century, efforts to com- compiles the hazard assessment of the inventoried mercialize PVC began in the early 20th century but chemicals graphically by flooring material type. Table 3 were initially stymied by its inherently rigid and on page 35 summarizes the chemical hazard strengths, brittle nature. The development in 1926 of plasti- weaknesses and potentials of each flooring material cizers to make PVC more flexible opened the door type by life cycle stage. to widespread applications across a broad spectrum of products and uses, from shock absorber seals and The analysis is primarily based upon literature studies insulated wire to raincoat and shower curtain coat- of the content, process and health impacts associated ings.27 The development of vinyl flooring from PVC with these flooring types generically – with only very followed quickly in 1933, but commercialization had limited data gathered from specific manufacturers. An to wait until after World War II when the produc- exception is made in the case of the polyolefins, where tion and use of PVC rapidly accelerated—gradually the investigation focuses on one particular product as supplanting linoleum until the last U.S. linoleum explained in that section. Individual manufacturers of plant closed in 1975.28 each of these materials may use some chemical com- ponents that vary from the generic standards described PVC is made by reacting ethylene (also called eth- here. Future work may focus on individual, manufac- ene and derived from petroleum or natural gas) with turer specific, product characteristics. chlorine gas (made from the electrolysis of salt brine) to make ethylene dichloride (EDC). At high tem- The analysis also focuses on the materials that make perature and pressure, the EDC then is decomposed to up the main body of the flooring product and does not make monomer (VCM), which is then address the and polyacrylate coatings now polymerized into long chains of molecules to make being increasingly used to reduce maintenance and emissions in a variety of flooring products. Nor does it address the adhesives used to secure these products, * Not all compounds called “vinyl” are actually PVC. In chemistry, which can have toxic properties as well. Future work the term “vinyl” actually has a broader meaning, encompassing under the Pharos Project26 will study these same issues a range of different chemical compounds derived at a manufacturer and product specific level, providing from ethylene. In addition to PVC, “vinyls” in building materials also can include: ethylene vinyl acetate (EVA, CAS #24937-78-8): a opportunity to evaluate more individual product spe- copolymer of ethylene and vinyl acetate, used in films, wire coating, cific variations – such as coatings and adhesives – and carpet backing, and adhesives; polyethylene vinyl acetate (PEVA): to differentiate manufacturers who are exceeding (or EVA or a blend of polyethylene and EVA used in shower curtains not) the industry norms. and body bags; polyvinyl acetate (PVA or PVAc, CAS #93196-02-2): a polymer made from vinyl acetate monomer (VAM) used in paints and adhesives, such as white glue; and (PVB, CAS #63148-65-2): used in safety glass films and recycled into carpet backing. For more, see PharosWiki article on vinyl at http://www. pharosproject.net/wiki/index.php?title=Vinyl.

14 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care PVC resin.29 Many additional chemicals beyond those covered in this paper are used to facilitate the chemical reactions that go into the production of PVC, includ- ing catalysts to trigger chemical reactions, polymeriza- tion accelerants and stoppers, solvents, emulsifiers, antioxidants, surfactants, coupling agents, initiator agents, and modifiers, plus a wide range of additives that are used to give PVC resins different performance characteristics.

Vinyl sheet flooring is made by mixing PVC resins, and stabilizers together with an azo com- polychlorinated dibenzo furans (PCDFs) and poly- pound that decomposes into nitrogen bubbles, mak- chlorinated biphenyls (PCBs)) that are known potent ing a foaming vinyl mixture. The foam is spread on a carcinogens, reproductive/developmental toxicants, backing of felt, wood pulp or other plastics. A pattern and endocrine disruptors.31 Because of their extraordi- is printed and then a second wear layer of PVC and nary potency, they are one of the few chemical groups is layered over the foam base. Sometimes targeted by a global treaty – the Stockholm Convention a polyurethane coating is applied on top to improve on Persistent Organic Pollutants (POPs)32 – and rank durability and reduce the need for waxing. in the Very High Concern category of our framework. The need to reduce dioxin formation in health care was VCT is created by mixing calcium carbonate filler, one of the drivers behind a landmark Memorandum of vinyl resin binders (sometimes PVC is combined with Understanding (MOU) between the American Hospital a small amount of vinyl acetate), plasticizers, stabiliz- Association (AHA) and the U.S. EPA to coordinate ers and pigments into a dough-like mixture, pressing efforts to minimize the production of PBT pollutants.33 the mixture through rollers, and cutting it into tiles. Health care’s recognition of PVC’s considerable role in In vinyl sheet goods, PVC resin is the single largest dioxin generation due to its chlorine content has been component, making up as much as 55% of the product, an important factor in driving substitution efforts.34 whereas in VCT, PVC may make up as little as 11% of the total product.30 PVC is, by far, the most widely sourced plastic polymer that uses chlorine in the United States, with 14 billion Persistent exposures pounds per year produced in the U.S. alone.35 The construction industry is responsible for more than 60% PVC is referred to as a chlorinated plastic or a haloge- of worldwide PVC use.36, * nated organic compound because it contains chlorine – one of the halogen elements – and carbon. Because The chlorine content also gives PVC significant fire of the chlorine/carbon combination, PVC’s life cycle resistance, yet the plasticizers required to make it flex- unavoidably produces dioxins, furans and other hazard- ible significantly reduce its fire retarding properties. ous halogenated compounds. Thus many PVC products still contain flame retardants to meet fire safety standards.37 Manufacturers use chlo- PVC manufacturing creates dioxins. So, too, does the rinated paraffins as fire-retarding plasticizers for PVC accidental or intentional burning of chlorinated plastic flooring and wire sheathing.38 The paraffins – as well as products. According to the U.S. EPA, the manufac- some of the other flame retardants used in PVC – are ture of PVC is one of the largest sources of dioxin and PBTs, aquatic toxicants and known carcinogens39 (see landfill fires are likely one of the largest sources of box on “Flame Retardants: Saving & Risking Lives”). dioxin formation from any human activity. PVC and other chlorinated plastics are the leading contributors to dioxin releases from landfill fires (see Appendix C: PVC and Dioxin). * Other chlorinated plastics used in building materials include: chlorinated polyethylene (CPE), chlorinated polyvinyl chloride Dioxins are a family of PBT chemicals (including (CPVC), chlorosulfonated polyethylene (CSPE), polychloroprene (CR certain polychlorinated dibenzo dioxins (PCDDs), or chloroprene rubber, also brand name Neoprene).

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 15 Flame Retardants: Saving & Risking Lives40

The high flammability of petrochemical plastics and reproductive and neurodevelopmental problems, other synthetic materials has led to the addition of immune suppression, and in some cases, cancer in chemical treatments to resilient flooring and other animal studies.44 interior finishes to meet fire safety standards. Scientists continue to investigate HFR exposure Halogenated flame retardants (HFRs), are often the pathways in humans. What is known is that HFRs are chemical treatment of choice, including polybro- released inadvertently during manufacture, emit- minated diphenyl ethers (PBDEs) and chlorinated ted during use into household dust,45 released in paraffins. Recent research, however, has raised burning, or released in landfill at end of life, mak- concerns about the persistence and toxicity of many ing their way into air, soil, food, waterways, wildlife, of these flame retardant chemicals.41 Some flame and humans. Biomonitoring shows that breast milk retardants are now ubiquitous in the environment, and other bodily fluids,46 and our rivers, lakes and including in remote areas such as the Arctic42 and streams, contain high levels of some HFRs.47 deep in the oceans.43 Rapidly increasing levels have been measured in sediments, marine animals and Alternatives to HFRs need to be screened carefully as humans indicating a significant potential for damage well. Both PVC and SBR frequently contain antimony to ecological and human health. Halogenated flame trioxide as an alternative fire retardant. Antimony retardants have been linked to thyroid disruption, trioxide is a known carcinogen.48

The PVC manufacturing processes also generate a Other heavy metals are still used as additives in PVC large number of highly toxic PBTs,49 including poly- products, including lead, cadmium and organotins, chlorinated biphenyls (PCBs) and hexachlorobenzene such as tributyltin. Lead is a carcinogen, endocrine (HCB). PCBs and HCB are known carcinogens, endo- disruptor and reproductive and neurodevelopmental crine disruptors and developmental toxicants targeted toxicant.54 Cadmium is a carcinogen, a developmental for elimination by the Stockholm convention.50 and reproductive toxicant and an aquatic toxicant.55 Tributyltin is an .56 While manu- PVC production is a significant source of PBT heavy facturers claim to be replacing these compounds with metals. Chlor-alkali plants that produce the chlorine safer alternatives, emissions continue (see below under gas for PVC production have been major sources of manufacturing exposures). Finally, polycyclic aromatic mercury emissions. Mercury is a potent developmen- compounds (PACs – known carcinogens57) also are by- tal neurotoxicant, endocrine disruptor and aquatic products of burning PVC.58 toxicant.51 In 2000, U.S. plants released 14 tons of mercury and were unable to account for another 65 tons of that year’s consumption, making them one of the largest sources of mercury exposure in the environ- ment.52 More U.S. plants have converted to safer tech- nologies in recent years, but six chlor-alkali plants in the U.S. still use mercury cell technology and a much larger number of similar plants still operate in Europe and the rest of the world.53

16 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care User exposures To make PVC flexible and versatile, the plastics indus- Pigments Can Be Toxic try blends it with a wide range of additives. In addition to the PBT metals listed above, there are a variety of All of the flooring materials studied — vinyl, other High Concern chemicals used to provide PVC rubber, polyolefins, and linoleum — share with its unique properties – most notably the common problems associated with certain plasticizers required to make it flexible. Many of these pigments added for coloration. For example, added chemicals do not permanently bind to PVC and carbon black and titanium dioxide are used as will migrate out of PVC products into the air, soil, dust, flooring pigments and to add other physical water, and be inhaled or ingested by humans.59 Plasti- properties to the materials. Carbon black is a cizers are not VOCs, so will not be evaluated by cur- possible carcinogen75 when inhaled as dust. rent standard indoor air quality tests (see box on “VOC Likewise, titanium dioxide is a possible car- Testing: Only Part of the User Exposure Story”), but cinogen76 through inhalation of fine dust. Toxic are increasingly being detected in both dust studies60 pigments such as carbon black and titanium di- and biomonitoring of humans.61 oxide will be of most concern for user exposure if they are in the surface layer of the flooring Flooring manufacturers add a variety of phthalate product and more prone to being worn off by plasticizers to PVC to give it flexibility. The most abrasion and released into dust. commonly used phthalates in vinyl flooring62 include three that are endocrine disruptors and reproductive or 63 developmental toxicants: butyl benzyl phthalate (BBP The wax and strip maintenance cycle necessary to keep or BzBP),64 di(2-ethylhexyl) phthalate (DEHP),65 and 66 vinyl sheet and tile good surfaces durable and shiny has di-n-hexyl phthalate (DnHP). Emerging evidence long been a source of health concern due to the toxic also links phthalates in PVC interior materials to respi- VOCs such as formaldehyde (a known carcinogen) ratory problems such as rhinitis and asthma,67, 68, 69, 70 71 used in the maintenance products and particulates obesity, and insulin resistance. Phthalate plasticizers generated in the process.77 A life cycle study of flooring typically comprise four percent of the total mass of installation and maintenance found that the amount of vinyl composition tiles72 and 20% or more of the mass 73 VOCs emitted from a single waxing of a floor may be of vinyl sheet flooring. comparable to the amount of VOCs emitted from the flooring itself over its entire life.78 Several PVC manu- PVC production uses the vast majority of phthalates in 74 facturers have formulated “no wax” finishes for some of the United States. The health concerns with phthal- their flooring products, but the issue remains a strong ate plasticizers have helped accelerate the health care driver toward alternative flooring material. industry’s efforts to eliminate PVC from medical prod- ucts, such as IV bags and tubing, and have informed the broader building movement’s effort to avoid PVC Manufacturing exposures in building materials. PVC manufacturing utilizes many highly toxic chemi- cals as primary ingredients. Manufacturers also add a variety of pigments in all of the floorings studied in this analysis, some of which can Ethylene is a likely neurotoxicant79 and there are prelimi- be highly toxic (see box on “Pigments Can Be Toxic”). nary indications that it may be metabolized into ethylene oxide, a known carcinogen and reproductive toxicant.80

The chlorine gas that is used to react with ethylene is an aquatic toxicant and highly acute toxic gas81 and a terrorist attack concern.82 But of even higher con- cern are the chemicals at the next steps in production: ethylene dichloride (EDC) is a likely carcinogen83 and vinyl chloride monomer (VCM) is a known carcinogen as well as a neurotoxicant.84

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 17 characteristics in vinyl products. This review found no biobased content incorporated into any vinyl flooring products nor any potential for replacing any significant part of vinyl chemistry directly with biobased materials.

End of life The vinyl industry has aggressively marketed its efforts to recycle PVC, but has accomplished only limited recy- cling of post-industrial content – primarily its own pro- duction scraps. While PVC is technically recyclable, the multitude of additives used in different combinations in each product required to make PVC useful have made large scale post-consumer recycling nearly impossible for most products. Of an estimated 2.9 billion pounds of PVC discarded in the U.S. in 1999,91 only 18 million pounds – just over 1/2 of one percent – was recycled.92 Furthermore, the presence of PVC can interfere with the recycling of other plastics. The Association of Post- Consumer Plastics Recyclers declared efforts to recycle PVC a failure and labeled it a contaminant in 1998.93 The PBTs and additives listed above are potentially problematic in the manufacturing facilities for work- ers and for residents in neighboring communities. In addition to the PBTs described above that are released B. Rubber flooring in the production of PVC itself, vinyl flooring manu- facturers recently reported releases of airborne phthal- Natural rubber from the sap of plants was a material of ates, 1,1,1-trichloroethane (likely neurotoxicant and choice for hundreds of years for many products requiring ozone depletor85), zinc and acrylic acid (both aquatic durability, resilience and elasticity. In fact, the first resil- toxicants86), vinyl acetate (a suspected carcinogen87), ient flooring was made from natural rubber sometime and a variety of other VOCs and solvents. Vinyl floor- in the 12th or 13th century.94 Supply problems during ing manufacturers claim that lead compounds are no World Wars I and II led to the development of synthetic longer used as stabilizers in their products, but signifi- replacements for natural rubber.95 Styrene butadiene cant releases of these carcinogens and neurotoxicants88 rubber, known as SBR, was the first mass produced syn- continue from several plants – over 1,000 pounds from thetic rubber, developed by chemists at I.G. Farbendus- one plant alone in the year 2006.89 trie AG of Germany in 1929.96 Synthetic rubber now meets more than 70% of global rubber demand.97 Renewable content Most vinyl resilient flooring for health care applications SBR is manufactured from styrene and 1,3-butadi- uses no or only a very small amount (<5%) of recycled ene. 1,3-butadiene is a gas derived from petroleum, content, which is almost entirely post-industrial mate- produced as a byproduct of ethylene production and rial content used as filler, rather than as a replacement extracted using solvents such as acrylonitrile or dimeth- for the PVC. While there are a few products claiming ylformamide. Styrene is made from ethylbenzene, higher recycled content, it is almost entirely post- which is in turn made from ethylene and benzene, also industrial waste that is being recycled.90 When a new a petroleum product. As with PVC, a wide range of PVC floor comes to market, the majority of the product chemicals are involved as intermediates and additives is made from virgin PVC. Recycling of post-consumer in the manufacture of SBR including catalysts, polym- material is challenging for PVC – as it is for some of the erization accelerants and stoppers, solvents, emulsifiers, other polymers reviewed here – because of the many antioxidants, surfactants, coupling agents, initiator different additive blends that change performance agents, and modifiers.

18 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care CASE STUDY Brigham & Women and Nora Rubber

As early as 2000 when Rick Bass, Director of Environmental Services, began working at Brigham and Women’s Hospital (BWH), he identified issues with vinyl flooring, in particular the high costs and health effects associated with care and maintenance of VCT. The frequent stripping and waxing of VCT floors, not to mention the toxic properties of the chemicals to undertake the activity, had led him to investi- gate alternatives that would perform equal to, if not better, than VCT without the accompanying nega- tive aspects. Nursing staff exposed to the odors associated with the VCT cleaning products, even the low VOC products in use, identified health issues associated with the chemicals. Moreover, as a hospital with a normal occupancy approaching 100%, BWH was finding it challenging to maintain the VCT, which required vacating entire units, erecting plastic barriers, and increasing filtration during the VCT refinish- ing regimen.

Noting that most hospitals install rubber flooring Robert Wood of: Courtesy Johnson Foundation Nora Rubber Flooring; Photo by: Tyrone Turner; Brigham and Women’s Center; Hospital - Surgery in their stairwells in order to avoid the need for waxing or buffing while maintaining required slip resistance, he thought the product might warrant investigation as to its application in other areas of the hospital. The opportunity to look at rubber flooring for broader application arose when BWH was renovating an entire floor of its main tower in 2004. The floor included an Intensive Care Unit (ICU), which would benefit from no wax, no buff floors, particularly due to the sensitivities of ICU patients as well as the needs of staff. Bass knew that some Operating Rooms in BWH were using rubber or linoleum floors, so he looked to the experience with those units to evaluate the potential for using rubber flooring in the ICU. Based on his evaluation, as well as manufacturer presentations, BWH installed Nora rubber flooring on one complete floor of its main hos- pital tower (approximately 18,000 sq. ft.).

At approximately the same time, the BWH Planning and Construction team set out to specify materi- als for the new Carl J. and Ruth Shapiro Cardiovascular Center (Shapiro). They built upon the positive experience with the ICU pilot to specify resilient flooring for Shapiro. The team was led by a commit- ment from BWH leadership to achieve LEED silver certification. As a hospital running 24/7, BWH found accomplishing LEED Silver challenging, with very few energy reduction credits available due to the building’s intensive energy usage. To achieve LEED silver requirements, the team looked to innovative credits within the LEED rating system, and focused on attaining as many of the other points available as possible – including the reusable materials points.

Bass informed senior management that if VCT was specified for Shapiro, as many as 5 additional full-time equivalent employees would be required for VCT maintenance. Moreover, the BWH Depart- ment of Environmental Affairs expressed concerns regarding storing additional chemicals for VCT maintenance, chemicals that raised concerns relative to indoor air quality in the hospital. With 350,000 square feet of flooring to be specified – approximately 250,000 square feet of it resilient flooring — and the opportunity to put down a no wax, no buff, rubber floor, “the decision really made itself,” said Joe O’Farrell, Senior Project Manager at BWH.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 19 In 2008, the team installed approximately 250,000 square feet of Norament rubber flooring in Shapiro. The team has found that the rubber floors perform far better than VCT. They knew that rubber flooring would be easier to maintain—added benefits include fewer color aberrations and no shrinkage. The challenge for them with the rubber flooring was the labor costs associated with installation. The rubber flooring requires more smooth subflooring and precise adhesion in addition to longer cure time, so the floor prep was quite labor intensive. They initially had some problems with bubbling, but those issues have been mitigated as the installers have gained expertise in installing the flooring.

BWH has received feedback from clinicians and others associated with the hospital that the floors are more comfortable, reduce noise, and release “no smell.” Some patients and staff miss the “shine” associ- ated with VCT, commenting that the dull luster of rubber makes it appear less clean than VCT. BWH’s response has been to educate staff to the differences between appearance and maintenance of the two products, and those perceptions are lessening. While it’s only been in place at Shapiro since July 2008, the

experience with Nora floors has led BWH to consid- Robert Wood of: Courtesy Johnson Foundation Nora Rubber Flooring; Photo by: Tyrone Turner; Brigham and Women’s Center; Hospital - Surgery er rubber flooring as the hospital resilient flooring standard for all major projects going forward.

About Brigham and Women’s Hospital: Brigham and Women’s Hospital is a 777 bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. The Carl J. and Ruth Shapiro Cardiovascular Center is a 136-bed facility that is anticipating LEED silver certification by spring 2009 and is one of the most advanced cardiovascular care facilities in the world for patients and their families.

SBR has now been joined by more than 20 other aromatic compounds (PACs) which are carcinogens.104 synthetic rubber formulations including polybutadiene, Additionally, chlorinated paraffins, decaBDE and other ethylene propylene (EPDM), acrylonitrile-butadiene flame retardants used as additives in SBR and other (NBR, also called nitrile rubber), polychloroprene rubber products may include PBTs, known carcinogens, (also called neoprene), synthetic (rather than natu- endocrine disruptors and aquatic toxicants105 (see box ral) polyisoprene, silicone, and ethylene vinyl acetate on “Flame Retardants: Saving & Risking Lives”). (EVA). Natural rubber is still used as a component in some health care flooring products, but generally User exposures comprises only a small fraction of the total content of The flame retardants referred to above remain in the rubber flooring materials. SBR is far and away the most final product, creating a significant user exposure con- prevalent of the rubber materials now in use for resil- cern with rubber flooring. ient flooring,98 with annual global production of over 13 million metric tons, growing at 5-7% per year99 and Some testing has indicated residuals of styrene (possi- is the focus of this analysis. ble carcinogen and likely neurotoxicant and endocrine disruptor106) from manufacturing in rubber flooring Persistent exposures products. Several SBR flooring products that health With no chlorine content, SBR is not a significant care organizations use have passed emissions testing, source of dioxins.* SBR plants do, however, release but concerns remain about the aggregate effects of the significant amounts of other PBTs,100 including lead,101 range of VOCs that are emitted by these floors despite mercury,102 benzo(g,h,I)perylene103 and other polycyclic the fact that each chemical individually tests below VOC threshold standards. In some instances, the industry has not yet established threshold standards for * Unlike SBR, neoprene rubber (polychloroprene), another synthetic rubber, is a chlorinated plastic and is a potential source of dioxin some of the chemicals (see box on “Indoor Air Quality when burned. Problems with Recycled Rubber Floors”).

20 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care CASE STUDY St. Joseph and Mondo and Nora Rubber, Stratica Polyolefin and Forbo Linoleum

Approximately four years ago, St. Joseph Health System (SJHS) decided to move to PVC-free interior fin- ishes. This was decided as part of their goal to provide healing environments with improved air quality standards for their patients.

Unlike other large health systems that hire architect and design firms to specify their materials, SJHS specifies all its interior finishes through their corporate office, coordinated by the Director of Interior Design and Space Planning, Dawn Fredrick-Seibert. Ms. Fredrick-Seibert is committed to specifying products that are safe for patients, staff, and the environment and engaged an interior design consul- tant to research healthier materials to find replacements for PVC. Rubber Flooring; Photo by: Solar EyeRubber Flooring; Solar Communications Photo by: Queen of the Valley Center; Center Mondo Medical - Surgery As part of their PVC-free commitment, SJHS searched for alternatives to the vinyl sheet goods and VCT flooring they used throughout their many hospitals. SJHS had already been using rubber flooring in the Operating Room environ- ment in order to meet the code requirements. In their Operating Room experiences they found that the rubber flooring did not require wax or any other surface finish, which both improved air quality and decreased maintenance costs.

St. Joseph’s Hospital in Orange County, Califor- nia undertook renovation projects to test rubber flooring in other contexts. The design team and

user groups evaluated the rubber products in EyeNora Rubber Flooring; Solar Communications Photo by: St. Joseph Hospital; Patient Care Center - Operating Room; use at St Joseph’s and found that they met the clean air, care and maintenance requirements.

Based on the results of that test, SJHS made the decision to stop sourcing vinyl and VCT and have not installed a single project using PVC since. For major renovations, the system will take the oppor- tunity to go into a facility and strip out the VCT and replace it with healthier alternatives whenever the budget allows. For new construction, the addition- al capital cost associated with non-vinyl flooring is built into a project from the very beginning.

Each of the alternative materials discussed in this paper are now used in different situations in SJHS hospitals, including Nora Rubber and Mondo Rubber. SJHS Queen of the Valley Hos- pital in Napa Valley chose Mondo rubber sheet goods for use in its operating rooms and Strat- ica and Forbo Marmoleum linoleum in other

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 21 areas of the hospital. System users are Nora Rubber, Stratica, and Forbo Linoleum St. Joseph Hospital; Patient Care Center - ICU Patient Room; satisfied with the flooring products, the strongest attribute being a wax and fin- ish free flooring system. The room turn over rate has vastly improved. About St. Joseph Health System: Founded in 1982, St. Joseph Health System is a not-for-profit Catholic health care system with facilities in Northern and Southern California, as well as West Texas and Eastern New Mexico. St. Joseph operates 14 hospitals, 3 home health agencies, and multiple physician groups. For fiscal year 2007, St. Joseph had net revenues of $3.69 billion.

Some SBR manufacturers have historically used mercury associate considerable risks with 1,3-butadiene expo- as a catalyst to trigger chemical reactions in the manufac- sures in synthetic rubber factories. Research published turing process. In fact, regulators have measured mercury in 2007 found an association between leukemia rates for emissions from some older rubber floors.107 The extent of synthetic rubber workers and 1,3-butadiene exposures, current mercury catalyst use in the industry and residu- independent of other chemical exposures.113 Earlier als in newer products is not known, but at least two SBR studies correlated 1,3-butadiene workplace exposures to manufacturers are continuing to release mercury from increased mortality from arteriosclerotic heart disease.114 their manufacturing processes, as indicated by 2006 Toxic Release Inventory (TRI) emissions reports.108 In 2006, SBR manufacturers reported releases of 778,000 pounds of styrene115 (a carcinogen and neurotoxicant116). Some flooring users have raised concern about latex Other chemicals in the TRI releases include polycyclic allergies associated with rubber floors. Most rubber aromatic compounds, lead, mercury, acrylonitrile (car- flooring is not, however, expected to trigger latex aller- cinogen and neurotoxicant117), ethylbenzene (carcino- gies simply because there is so little natural rubber in gen118), benzene (carcinogen developmental toxicant the products. The primary component of rubber floor- and mutagen119), and a variety of acute toxicants.120 ing is synthetic rubber, made from different compounds than the proteins in natural latex rubber that trigger Additional workplace hazards (though not appearing in allergies. Manufacturers assert that the allergenic latex TRI reports) are dithiocarbamates used as polymeriza- proteins in natural rubbers are totally destroyed in the tion accelerants and stoppers that are endocrine disrup- vulcanization process, though no independent testing tors and neurotoxicants121 and dimethylformamide, sources were identified to confirm this. used as a solvent to extract 1,3-butadiene from petro- leum122 that is a likely developmental and reproduc- Manufacturing exposures tive toxicant123 and ethylene (see box on “Ethylene’s Problematic Ethylene Oxide Connection”). SBR plants in the U.S. report major releases of other highly toxic chemicals from their processes, in addition to the PBT releases referred to above.109 Combined TRI Renewable content reports for the seven U.S. SBR manufacturing plants Select rubber flooring products contain high post-con- show releases of almost 2,000 tons of TRI chemicals sumer recycled content, some as high as 100%.124 The annually from those plants.110 post-consumer recycled content, however, is primarily sourced from tires and may contain toxic materials Over 1.4 million pounds of 1,3-butadiene are released that make their use in interior environments question- annually to the atmosphere from petroleum refiner- able. (See box on “Indoor Air Quality Problems with ies and manufacturers of 1,3-butadiene, plastic resins, Recycled Rubber Floors”). and synthetic rubber.111 1,3-butadiene is a carcinogen and reproductive & developmental toxicant.112 Studies

22 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care Some health care flooring products contain natural rubber, harvested from rubber trees. But when used, Indoor Air Quality Problems these renewable materials generally comprise a small with Recycled Rubber Floors fraction (15% or less*) of the total content. Manufac- turers blend natural rubber with higher percentages of Many rubber flooring products contain recycled SBR; therefore, the flooring products still have all the rubber content. Much of the recycled content is toxic chemical problems of SBR. There are flooring post-industrial synthetic rubber from the com- products made entirely from natural rubber,131 but to panies’ own operations.125 A variety of resilient our knowledge, those products are not used in the flooring products – both sports floors and floors health care sector and are not reviewed here. Note intended for regular commercial interior use – also that although natural rubber is a biobased renew- contain high amounts of post-consumer rubber able, it has other significant production issues beyond recycled content. These are generally made from the scope of this analysis – most notably that work- 126 vehicle tires. Scrap tires pose a large disposal ers on rubber plantations in Africa and East Asia are problem, so the search has been on for beneficial reportedly working in near-slave conditions with much reuse opportunities. The introduction of scrap tire exploitation of child labor.132 materials inside buildings potentially can intro- duce significant chemicals of concern into the in- door environment. Products made from recycled End of Life tires can contain high levels of VOCs, which can A few rubber flooring manufacturers offer to take their be carcinogens or reproductive toxicants, includ- SBR products back at the end of life,133 though the fate 127 ing naphthalene, toluene, and aniline. of the returned product is not clear. Given that most SBR products are actually complex composites of SBR Although some of the high recycled content and other materials that are difficult, if not impossible, rubber floors have passed VOC emissions to disaggregate, recycling of rubber flooring on a large testing sufficient to be listed on the CHPS Low scale is not easily achievable. Emitting Material table,128 health care designers have been reluctant to specify them and it is not clear if these products are yet finding significant Virtually all SBR flooring ends up in landfills or use in health care applications. A State of Califor- incinerators. While various industrial facilities burn nia report found that 4 of 11 rubber flooring tire-derived fuel (TDF), including cement kilns, pulp products made with high recycled content did and paper mill boilers, electric utility boilers and other not pass VOC emissions criteria.129 Furthermore, industrial boilers,134 there is no infrastructure in place all 11 emitted a wide range of chemicals at to collect used SBR floor for TDF burning. We have levels high enough to lead California and others identified no studies that characterize the by-products to recommend against the use of tire-derived of burning SBR flooring. Comparable TDF facilities rubber-based products in most indoor environ- burning scrap tires, however, emit many carcino- ments. The test results also led the State of Cali- gens and neurotoxicants (including developmental fornia to begin work to establish reference levels neurotoxicants),135 such as benzene, chloroform,136 for chemicals in order to address emissions from 1-2-dichloroethane (DCE), methylene chloride,137 130 tire-derived recycled rubber products. lead, and mercury.

* Mondo products in North America for example use 3-13% natural rubber while SBR comprises 30-50% of the product (e-mail communication from Erika Marcoux, Technical Department Supervisor, Mondo America, Inc. February 10, 2009). Nora Rubber’s Noraplan has 10% natural rubber, 20% SBR, 55% clay filler, 5% pigments and 10% post industrial recycled content. Norament contains no natural rubber and is 45% SBR, 45% clay, 5% pigments and 5% other post industrial recycled content (Nora product literature www.norarubber.com).

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 23 C. Polyolefin flooring Lack of Emissions Availability A variety of new polyolefin-based materials have been Outside of the U.S. introduced into the flooring market in recent years. These materials generally consist of blends or laminates of dif- For PVC and SBR, this analysis review utilizes ferent polymer blends – largely ethylene-based – usually emissions data from the U.S. EPA’s Toxic Release Inventory (TRI) to inform assessment of chemi- with some calcium carbonate (limestone) filler. They cals involved in the manufacturing process all claim high durability and no wax maintenance. The and released to the environment. We have not term polyolefins covers a wide range of different blends, found this type of data for either linoleum or many proprietary in nature, making it difficult to general- Stratica-related facilities. Most of the manufac- ize about polyolefin flooring. This analysis is focused on turing of both materials is located in European a single example product – Stratica by Amtico. Stratica countries with less detailed reporting require- is selected because it is the polyolefin resilient flooring ments for manufacturing facilities than the product that has been longest on the market (over 10 U.S.139 The analysis is, therefore, restricted to years) and is the most widely used of the polyolefin floor- analyzing both materials based only on what ing options in health care today, with the most informa- we have learned about their contents and what tion available on its make up and use. Polyolefin is a very we can project from contents and process generic term and this analysis of the Stratica product is about possible emissions. not necessarily representative of other polyolefin-type products. This selection also should not be read as an endorsement of Stratica over other polyolefin products. The only indication of potential PBT activity is the Stratica comes in both tile and plank styles, but is too presence of 2-propenoic acid in the Lotryl ethylene/ rigid for larger sheet goods. Manufacturer marketing methacrylate copolymer.140 The chemical is under emphasizes the resilience of the top layer of Surlyn – an investigation by the Stockholm Convention as a pos- ethylene/methacrylic acid (E/MAA) copolymer with zinc sible chemical that may degrade to Perfluorooctane – the same material that is used on golf balls. E/MAA is Sulfonate (PFOS), a PBT.141 made from isobutylene and tert-butanol, oxidized into methacrolein and then to MAA and then polymerized with ethylene into E/MAA. Behind the Surlyn, Stratica User exposures is made from layers of ethylene/methyl acrylate and tri- There is very little indication of potential significant user methylolpropane trimethacrylate (TMPTMA) backing. exposure issues associated with Stratica, based on the Finally there are binders of ethylene/maleic anhydride materials used to make the flooring product. Like all of terpolymer or ethylene vinyl acetate and fillers of com- the other flooring materials in this review, Stratica passes mon minerals (calcium carbonate, kaolin or hydrated alu- the current indoor emissions certifications but does have minum oxide). See Appendix D: Composition of Stratica a significant number of VOC emissions that are either for a full discussion of the contents of Stratica below threshold or have no established threshold (see box on “VOC Testing: Only Part of the User Exposure Persistent exposures Story”). Stratica contains carbon black and titanium dioxide compounds in the last 2 of the 6 layers, not in Amtico literature asserts that Stratica contains no chlo- the surface wear layers, therefore these chemicals are rine138 and our research did not uncover any evidence unlikely to be released as dust (see box on “Pigments that halogenated compounds or other PBT chemicals are Can Be Toxic”). The zinc in Stratica is an aquatic toxi- used or emitted in the life cycle of the product (see box cant.142 Because zinc is in the surface layer, it could wear “Lack of Emissions Availability Outside of the U.S.”). off and be washed down drains into sewage systems. The levels possible are probably insignificant in comparison to zinc handled by sewage systems from other sources.

24 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care CASE STUDY Kaiser Permanente and Stratica Polyolefin

Kaiser Permanente’s (KP) annual spending for purchased products and services is approximately $13 bil- lion. The system leases or owns more than 65 million square feet of real estate and has a ten-year capital plan of more than $30 billion. Despite this leverage, KP has experienced limitations in achieving its goal of using products and materials that are environmentally sustainable.

Kaiser Permanente, as both a building owner and operator, has always had to look beyond first costs (the cost of installing a product) to recognize that there are additional costs of using a product over its life. As a not-for-profit, pre-paid health system, KP focuses on preventive medicine both in care delivery and in understanding the connection between environmental risks and public health outcomes. KP’s organiza- tional model and culture has made KP open to addressing environmental issues, in that it understands that reducing environmental exposures to staff, patients, and the community at large is part of “total health.”

KP’s Environmental Stewardship Council guides the health system’s environmental work. Its vision statement reads: “We aspire to provide health care services in a manner that protects and enhances the environment and the health of communities now and for future generations.” In its commitment to en- vironment and health, KP has developed its own chemicals disclosure document that is required for all large national purchasing contracts. The disclosure asks for information on the categories of: persistent bioaccumulative toxic compounds and carcinogens, mutagens and reproductive toxins in addition to specific existing and emerging chemicals of concern such as mercury, polyvinyl chloride (PVC), phthal- ates, bisphenol-A and halogenated flame retardants.

In its efforts to remove hazardous chemicals by purchasing safer products, almost eight years ago, KP’s Tom Cooper, National Manager, Sustainable Building Design and Research, spearheaded the health care system’s efforts to look at replacing PVC building materials with alternatives. Many of the medical centers and office buildings had been using vinyl sheet goods and/or VCT (made from PVC) as resilient flooring options. As part of the effort to ensure the use of environmentally sustainable products, KP’s green build- ing committee undertook a research project evaluating resilient flooring alternatives to vinyl and VCT.

Resilient flooring alternative products had a higher first

cost than the VCT that KP was using. They learned, however, Permanente of Kaiser Photo courtesy PermanenteKaiser Center, Medical Santa Teresa-San Jose; Stratica; that the alternatives might actually be less expensive than VCT, when evaluating the full costs of the flooring over the life of the product. They noted a Florida hospital study of different flooring types and costs associated with health care, including carpet, rubber, linoleum, and VCT. The Florida study showed that the total cost of VCT was higher across its lifespan than any other material.

KP’s facilities teams identified that there was ongoing disruption in operations every time they had to strip and wax a vinyl floor, especially in inpatient facilities. Some staff complained about headaches and there was some docu- mented work loss associated with this process. Based on the desire to reduce PVC in KP facilities and information that VCT might actually cost the system more over time, Cooper and colleagues undertook a multi-tiered strategy to test and evaluate no-wax flooring alternatives.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 25 They looked at products that had already been used in the U.S. mar- Permanente of Kaiser Photo courtesy PermanenteKaiser Center, Medical Santa Teresa-San Jose; Stratica; ket and focused on products that were used in high traffic areas, like health care. KP created a research team of internal staff and consul- tants to coordinate the effort. They sought a product that would be no wax, in order to prevent the maintenance disruptions associated with VCT and reduce the lifecycle cost. They reviewed product mar- ket data, traveled to sites where products had already been installed to see them in person, got references from the manufacturers, did a preliminary cost analysis based on each manufacturer’s cleaning protocols, and then installed four different products in KP facilities as a pilot project. One such product was Amtico’s Stratica (a polyolefin- based product).

KP’s National Environmental Health and Safety (NEH&S) team evalu- ated the Stratica in the pilot site for emissions: they collected data as to aesthetics, comfort, cleanability, stain removal, and chemical testing. KP maintenance staff were specially trained by Amtico on cleaning protocols. The final outcome after ex- Permanente of Kaiser Photo courtesy PermanenteKaiser Center, Medical Santa Teresa-San Jose; Stratica; tensive evaluation of Stratica was that it was a product KP would be interested in specifying: it required no finish, was aesthetically pleasing, withstood stain testing, had little to no off-gassing, had improved coefficient of friction over a waxed floor, had better acoustic properties, and was PVC- free. KP had enough information to put together a business case identifying the benefits and potential problems with Stratica and to recommend a combination of Stratica floor- ing and Nora rubber flooring (which underwent a similar pilot testing process) as their national design standard for resilient flooring for large renovations and new buildings.

KP has indicated that Stratica is not without its challeng- es. It only comes in tile and planks, so KP cannot source it for areas of their facilities where sheet flooring is required for infection control purposes. Because the maintenance and cleaning requirements are so different from vinyl, it cannot be installed where it will be surrounded by vinyl because it will not be properly maintained. The installation process requires no point load on the floor for 48 hours, requiring careful planning in terms of construction time and creative strategies (such as covering new floors with protective sheeting) in ex- isting facilities to avoid significant disruption in services. Finally, despite lots of education and training, some facilities still wax Stratica to get the shiny look that folks have become accustomed to in hospitals. Where the proper cleaning protocol is followed, KP is seeing a 50% to 80% reduction in maintenance costs over time. These maintenance savings haven’t paid back the higher first cost of the flooring yet, but good indicators are emerging. Feedback from patients and staff is that Stratica has improved acous- tics, comfort, and aesthetics. Importantly, injuries appear to be reduced on the new flooring and KP is optimistic that it will be able to quantify reductions in costs for slips, trips and falls, absenteeism, and other metrics over time and understand the complete business case for this material.

About Kaiser Permanente: Founded in 1945, Kaiser Permanente is the nation’s largest nonprofit health plan, serving 8.6 million members in nine states and the District of Columbia. Kaiser Permanente operates 1,020 medical and administrative buildings including 500 ambulatory care facilities and 35 acute care hospitals. KP includes 65 million square feet of facilities and 14 million square feet of parking. There are 164,000 employees and 14,000 physicians. Total operating revenue for fiscal-year 2008 was $40.3 billion.

26 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care Manufacturing exposures End of life One potential metabolic decomposition product of eth- Post-consumer Stratica waste theoretically can be ylene is a carcinogen (See box on “Ethylene’s Problem- recycled into backing for more Stratica flooring; atic Ethylene Oxide Connection”), and the formalde- however, the removal of adhesives is a challenge and hyde used in the synthesis of the trimethylolpropane the company has not yet developed facilities for this binder is also a carcinogen.143 As with the other three process.150 “Down-cycling” Stratica into backing would flooring material types, the pigments may include be an improvement over current completely virgin carcinogens (see box on “Pigments Can Be Toxic”) production, but would not constitute a true completely and require care in usage industrially. The rest of the closed-loop system, since the use of the recycled poly- materials used in manufacture include serious irritants olefin would be limited to backing – replacing some or and corrosives that also require significant industrial all of the filler – yet the face layers would still require protection measures for occupational safety from acute new fossil fuel-based polymer production. hazards, but do not pose any known chronic cancer, mutagenic, developmental or reproductive hazards.144 D. Linoleum flooring Ethylene’s Problematic Linoleum, invented in 1860 by Englishman Frederick Ethylene Oxide Connection Walton, brought resilient flooring to the masses. Until the late 19th century, most floors were bare wood or Ethylene is the building block of many of the layers of Stratica and other polyolefins and dirt, with only the wealthy able to afford carpets or also the styrene and butadiene of SBR. It has rubber floors. Linoleum and similar coverings were been evaluated for cancer potential repeatedly the dominant flooring option until the 1960s when and determined not classifiable.145 However, synthetic materials began to replace linoleum. preliminary studies indicate that in nature and in humans, a small fraction of inhaled ethylene The name linoleum comes from the Latin word, linum, can metabolize to ethylene oxide, 146 a carcino- which means flax, and oleum, which means oil, named gen, mutagen, neurotoxicant and reproduc- after the primary ingredient – linseed oil extracted from tive toxicant.147 A study in Sweden found that the flax plant. The basic formula to produce linoleum ethylene metabolized to ethylene oxide in has remained the same for almost a century. Linseed plastic industry workers, although at a very low oil is oxidized to thicken it and give it a rubber-like conversion rate.148 Ethylene is also a neurotoxi- quality. The oxidized linseed oil mixture is mixed with cant at high levels of exposure.149 resins from pine trees, wood flour, cork and limestone fillers (and some pigments) and pressed onto a backing to make sheet linoleum.

Today, the linoleum manufacturing process is quite Renewable content similar to the process hundreds of years ago. The most Amtico claims a 100% recovery rate for Stratica’s significant change has been the use of tall oil to replace post-industrial waste, but the product itself has no some of the linseed oil. Tall oil is a by-product of the post-consumer recycled content, no known post- Kraft process used in pulp and paper manufacturing. industrial content other than Amtico’s own, and no biobased content. Modern linoleum is often coated with UV-cured poly- urethane or polyacrylates to reduce VOC emissions from the oxidation process of the linseed oil and to improve resilience and reduce maintenance. Many sheet linoleum products are still backed with the traditional woven jute, while tile products utilize other backings made from poly- ester or glass fibers to provide greater rigidity.151

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 27 CASE STUDY Maimonides Medical Center and Forbo Linoleum

Maimonides Medical Center, Brooklyn, New York, has a long history working with Guenther 5 Architects (now part of Perkins+Will). “We understood early on the link between environmental health and the materials we specified for health care projects,” said Jason Harper, Associate Principal from Perkins+Will. “We recommend products that contribute to improved indoor air quality. Any material that can reduce VOCs and be maintained with greener cleaning protocols is our preference. We try to avoid specifying flooring products that require wax and strip procedures, for example.”

When Maimonides partnered with the firm to undertake renovations throughout the medical center, and later with the design and construction of a major addition, the commitment to sustainability drove the project partnership. Maimonides began piloting alternatives for vinyl flooring. The design team first recommended linoleum for small renovation projects (such as an 800 square foot family lounge), then in corridors for larger renovation projects, including a large full floor renovation that created an entire new 30 bed patient unit (using linoleum in the corridors and Stratica in the patient rooms). Through these pilots, Maimonides became comfortable with both performance and maintenance.

With the initial projects, the facilities FrankPhoto by: Oudeman Health Center;Maimonides Forbo Linoleum; staff noted positive reactions from staff, patients, and visitors. Linoleum reinforced the natural look that the design strived to achieve and provided other aesthetic ben- efits –it was colorful and provided pattern- ing capabilities for areas of the hospital like the pediatric wing, where design could play an important role in the comfort of patients. It was softer and quieter. More- over, the reduced maintenance costs in human power and absence of chemical cleaning agents—the material requires no waxing or stripping—meant that staff and patients with allergies and other health issues were protected. Photo by: PaulPhoto by: Rivera Health Center;Maimonides Forbo Linoleum; At the same time, Maimonides faced challenges throughout its pilot projects with regard to mainte- nance of the floors. While the medical center chose linoleum in part for its no wax attributes, when it was installed in areas adjacent to existing vinyl floors that needing to be stripped and waxed, staff often waxed the new linoleum floors as part of their normal maintenance practices. As Environmental Services staff became more comfortable with the reduced maintenance requirements of linoleum, the additional benefits associated with reduction in chemical use and labor required to wax and strip began to be realized.

28 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care With a variety of pilot projects using linoleum, Maimonides was prepared and committed to specifying linoleum throughout a 9-story, 100,000 sq. ft. addition and 50,000 sq. ft. of related renovations, includ- ing a NICU, Surgery, Obstetrics, and Critical Care. “The President was very much committed to greening the hospital,” said Derek Goins, Senior VP of Facilities and Support Services. “We felt sustainability was the right thing to do for the institution. You need a commitment from the beginning and going forward. And, you can’t do it half way.”

The design team was able to demonstrate potential life cycle cost savings to Maimonides if it were to specify non-vinyl alternatives (the project includes linoleum, Stratica, and rubber). While there might be a higher “first cost” for the installation of linoleum, they calculated significant savings throughout the life of the product – an estimated 3-5 year payback when projecting the reduced costs associated with maintenance of a linoleum floor. Mr. Goins said, “You believe there may be a savings, but it’s really hard to quantify. You just have to have the commitment to sustainability.”

Maimonides is satisfied with their new linoleum and they continue to source it for many of their new projects. It is not without its installation challenges. The adhesives require 48 hours with no traffic on the floors after installation, which now is built into the construction time line. And, the subfloor

preparation protocol for installing linoleum to Health Center; Maimonides Forbo Paul Linoleum; Photo by: Rivera ensure a smooth, flat surface to avoid buckling and bubbling comes with higher first costs as well, both in new construction as well as reno- vation. Goins confirms that the hospital hasn’t experienced chronic ongoing performance issues with the linoleum—the materials are performing acceptably.

About Maimonides Medical Center: Founded in 1911, Maimonides Medical Center is one of the largest independent teaching hospitals in the nation, with more than 700 patient beds, over 90,000 emergency room visits, 230,000 ambulatory care visits, and 7,200 births each year.

Persistent exposures Two linoleum products failed product VOC emissions 155 We know of no PBTs used or released in the manufac- testing in a State of California study due to emissions ture of linoleum or elsewhere in its life, with the notable of acetaldehyde (a respiratory irritant and carcino- 156 exception of in the farming of the flax used as a feed- gen ). Manufacturers have begun to successfully stock. At least one of the pesticides approved for use address the odor and VOC problems associated with 157 on flax – Trifluran,152 is a PBT as well as a carcinogen, linoleum – through use of less odorous oil varieties endocrine disruptor and aquatic toxicant.153 This analysis and by reformulating surface coatings to reduce emis- 158 is constrained by the lack of emissions data to confirm sions. Linoleum flooring products from many of the our analysis of the manufacturing process (see box “Lack major manufacturers now are certified by FloorScore, of Emissions Availability Outside of the US”). GreenGuard, or otherwise meet the most stringent emissions standards (see box on “VOC Testing: Only User exposures Part of the User Exposure Story”). Linoleum has odor issues associated with the material, Like the other resilient floor materials analyzed above, much more than most synthetic flooring materials, due linoleum may also include carbon black and/or tita- to the oxidation products of linseed oil. Some products nium dioxide as pigments (see box on “Pigments Can made from linseed oil have not qualified for the Danish Be Toxic”). Another issue associated with old linoleum Indoor Climate Label due to their persistent odors.154 flooring is that some products made before 1979 con-

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 29 tained asbestos (carcinogen159) in the backing. While The one significant downside of the renewable con- asbestos is no longer used in today’s linoleum products, tent of linoleum is that current modern agriculture proper testing and remediation should be done for any practices lead to significant eutrophication (see box on disturbance or removal of linoleum (or other) flooring “Eutrophication Explained”). Eutrophication is one of tile products from pre-1979 installations.160 the few significant negatives found in life cycle assess- ment studies of linoleum (see Appendix A: Review of Manufacturing exposures Other Comparative Studies). The agricultural runoff problem that triggers this impact is a solvable problem Exposure to chemicals during the manufacturing process with better farming practices. At least one linoleum for linoleum depends upon the choice of modes for grow- manufacturer has been working with the Flax Council ing the flax and for processing the tall oil. Linoleum can of Canada to develop programs to train and encourage be manufactured without creating health exposures; flax flax farmers in more sustainable farming techniques.173 can be successfully grown organically without any toxic These programs are aimed both at reducing toxic chemicals. But in practice, a range of toxic pesticides chemical usage and improving field practices to reduce and fungicides are approved for use on flax, 161 includ- the runoff responsible for eutrophication impacts. ing the PBT trifluran (carcinogen, endocrine disruptor and aquatic toxicant162), mancozeb163 (carcinogen and endocrine disruptor164), bromoxynil (developmental 165 166 toxicant ) and trichlorfon, (neurotoxicant). Eutrophication Explained Another aspect of linoleum manufacturing that raises Eutrophication is a term for what happens when potential concerns is the processing of tall oil. Tall oil a lake or other body of water is overloaded with is usually esterified, first with polyhydric alcohols and nutrients. This can happen from sewage laden sometimes with the use of maleic anhydride (MA), with phosphate detergents, industrial outfalls, dimerized fatty acids, or pentaerythritol. MA is tradi- agricultural field runoff laden with fertilizers, tionally produced by oxidizing benzene (a carcinogen or any other manmade source of nitrogen and 167 and developmental toxicant ). Over the last two phosphorus. This essentially fertilizes the body decades, the MA industry, however, has begun to use of water and can lead to heavy growth of algae n-butane rather than benzene, in order to eliminate and other plants in the water, upsetting ecologi- potential benzene exposure.168 The pentaerythritol pro- cal balances. The growth spurt can in turn use cess is also problematic as this chemical is made from up the dissolved oxygen supply in the water, acetaldehyde and formaldehyde,169 both carcinogens.170 killing fish, making the lake uninhabitable, and degrading water quality. Good farming prac- Some linoleum processes prepare the tall oil with the use tices such as decreased fertilizer usage and soil of glycerol polyethers obtained by heating a polyhydric conservation techniques that diminish both the phenol with epichlorohydrin171 (a probable carcinogen amount of runoff and the fertilizer content of and reproductive toxicant172). It is not known how wide- the runoff can reduce or eliminate this problem. spread the use of the epichlorohydrin-based process is.

Other than these potential material problems, linoleum workplace problems appear to be primarily dust related End of life bronchial and dermal irritation. Starting in 2007, one linoleum manufacturer set up a pilot composting program in the Mid-Atlantic region. Renewable content The program collects and composts outdated samples, Linoleum sheet goods generally contain about 80% installation job site scraps, roll ends and trimmings renewable content – linseed oil, wood flour, cork, tall from the distribution facility. The program is diverting oil, rosin and jute. Some of the renewable content is nearly 20 tons of solid waste per month from landfills also post-industrial recycled material, with the wood and has reduced the amount of solid waste from the dis- flour coming from lumber mill waste and the tall oil tribution facility by 85%.174 Expansion to all of North from paper production. America is planned in the coming year. As with the other flooring products and their recycling challenges, adhesive removal continues to be a significant obstacle to the composting of linoleum at the end of its life.

30 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care SUMMARY: COMPARISONS AND RECOMMENDATIONS ON CHEMICAL HAZARD AND IVCLOSED-LOOP. CHARACTERISTICS

This section reviews and compares the chemicals Linoleum flooring also revealed only one PBT problem, of concern associated with each of the four flooring albeit also limited by the lack of access to manufactur- material types and where the potential exposures occur ing release data because manufacturing facilities do not in the life cycle of the materials. This is followed by a currently exist in the U.S. At least one of the pesticides review and comparison of their current and potential that may be used to grow the flax to make linoleum is a renewable material content and end of life strategies. In PBT. The problem is not integral to linoleum and can each case, issues that are integral to the materials used be solved by initiating organic growing techniques that are differentiated from issues that have the potential eliminate use of pesticides that are PBTs. to be improved with reformulation or different process decisions by manufacturers. Together, the analysis For both linoleum and polyolefins, it would be useful forms the basis not only for preferable product selec- to have access to emissions data from the European tion, but also for potential actions that designers and factories that make them in order to confirm that there specifiers can undertake to urge suppliers and manufac- are no PBT emissions from process chemicals that have turers to move toward desirable improvements in the not yet been identified in this analysis. life cycle profile of their products. Synthetic rubber flooring, specifically SBR, has more PBT Production PBTs involved in its chemistry and composition. Some of the PBTs in SBR – the halogenated flame retar- Many building products such as resilient flooring are dants specifically – can be replaced with non-PBT made with materials that result in the release of very alternatives. The other PBTs in SBR – mercury, lead high priority PBTs at one or more points in the life and polycyclic aromatic compounds – are not known cycle (see box on “PBTs Creating Global Challenges”). components but are reported in manufacturing emis- International treaties have prioritized reducing or sions and hence are likely additional process chemi- eliminating sources of PBTs. cals. Further analysis is necessary to determine if these chemicals can be eliminated from the SBR processes or All three of the petrochemical plastic-based materials are integral to it. studied here (vinyl, synthetic rubber and polyolefin) have a common heritage of problems with PBTs that Vinyl flooring has the most significant PBT challenges are released from drilling and refining operations. This in its life cycle. In addition to all of the PBTs identified analysis focuses on the issues that distinguish them in for rubber flooring above, the life cycle of vinyl flooring manufacturing and beyond once the petroleum has also results in the generation and/or release of several been extracted and refined. more PBTs, including dioxins/furans, PCBs and hexa- chlorobenzene, all of which are highest priority chemi- Polyolefin flooring, specifically Stratica, appears to cals identified in the Stockholm POPs Treaty. They are have relatively minimal problems in its life cycle with also all apparently unavoidable by-products of the PVC only one potentially problematic decomposition prod- manufacturing process itself. It is not possible for PVC uct identified, albeit limited by lack of access to manu- flooring manufacturers to eliminate these PBTs. facturing release data because manufacturing facilities do not currently exist in the U.S..

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 31 User exposure trioxide) is a carcinogen. SBR products also have prob- Sick building syndrome has made direct user exposure lems with various contaminants used during the manu- to chemicals from building materials an important facturing process, including styrene and heavy metals. issue in the design of buildings. User exposure to The heavy metals may be able to be eliminated from the toxic chemicals is a particular concern for interior product. Sample content testing with equipment such as * finish products such as resilient flooring. The large an x-ray fluorescence (XRF) device might help confirm surface area in occupied spaces in health care provides this. Styrene contamination may be more difficult to many opportunities to expose occupants to hazard- eliminate as it is integral to the manufacturing process, ous chemicals in the product, the adhesives, and the although process controls can probably reduce its pres- ongoing maintenance and cleaning. Most assessments ence in the final delivered product. It is unknown how and certifications aimed at evaluating toxics in prod- much styrene occurs through degradation of the SBR. ucts to protect users from exposure focus on indoor air Synthetic rubber flooring products made from recycled quality (IAQ) and specifically on measuring volatile content are particularly problematic because of the large organic compounds (VOCs) during and immediately number of toxic additives in the tires from which these following installation. Many resilient flooring products products are generally recycled. There is no known way made from each of the material types studied here pass to eliminate exposures. Some synthetic rubber users also current VOC emissions tests, but still may lead to user report odor issues. exposures to chemicals. Vinyl flooring shares with rubber the flame retardant Potential emission problems remain for each of the issues, using both halogenated flame retardants and material types. None of them are truly “zero VOC.” All antimony trioxide. Like rubber, PVC also has a legacy flooring types emit multiple problematic VOCs at lev- of heavy metal problems that warrant testing to ensure els below the established threshold levels for each indi- safety. Additionally, PVC is problematic due to the vidual VOC. No studies, however, have fully explored use of plasticizers that must be added to the polymer how multiple VOCs interact with one another. Further to soften it. Many of the plasticizers in common use in research is needed to understand the synergies between vinyl flooring products are High Concern chemicals individual chemical releases, and whether, combined, associated with cancer, reproductive and developmen- they will produce health impacts at much lower thresh- tal toxicity, and asthma. olds than one-at-a-time chemical tests would indicate. Health impacts of VOC emissions from the adhesives Manufacturing exposures and their interactions with the VOCs from the flooring Manufacturing of materials used to make resilient floor- products need to be explored. Related adhesive VOC ing products frequently includes the use of High and emissions are not consistently addressed by current Very High Concern chemicals. Beyond the intended VOC emission standards. Furthermore, some of contents of the product, there may be feedstocks, cata- the materials have chemical contents that are High lysts and other processing aids that are not intended Concern chemicals that are not VOCs, but can expose to leave the factory. These chemicals routinely escape occupants by contact or migration on dust. All of the from the factory via smokestacks, fugitive emissions, flooring types contain pigments such as titanium diox- outfall pipes or waste haulers, and may expose neigh- ide and carbon black that are potential carcinogens, boring communities to hazardous chemicals. Even although only if ground into fine dust and inhaled. when they don’t impact the surrounding community, these releases may pose a hazard to workers in the Linoleum & polyolefin flooring products have no factory. Workers in all four industries face hazards known chemical hazard problems for users beyond the from chemicals that are acute toxicants as well as the common low level VOCs and pigment issues referred to chronic health impact issues focused on in this analysis, above. Linoleum can have odor problems. Manufactur- but acute exposures are not the focus here. ers are developing ways to minimize this.

Synthetic rubber flooring products can include haloge- nated flame retardants and at least one of the non- * X-ray fluorescence (XRF) testing involves using a device that uses x-ray fluorescence to determine the presence and concentration of halogenated flame retardant alternatives (antimony a variety of chemicals, including many of the heavy metals.

32 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care None of the flooring materials studied can claim a Renewable content completely clean process that is certain to be safe for Using recycled or other renewable content can bring workers or for surrounding communities. Each of them benefits not only by reducing consumption of fossil also may contain and expose users to hazardous chemi- fuels and minerals but also can help avoid the toxic cals. They do vary, however, in how necessarily integral chemicals involved in the manufacture of prod- those compounds are to the process. ucts from virgin raw materials. The highest value is from using post-consumer recycled materials – those Linoleum flooring manufacturing may utilize any of captured at the end of use of the product. Most of the a number of High Concern carcinogens, including recycled content used in flooring materials today, how- benzene, formaldehyde and epichlorohydrin. However, ever, is post-industrial, not post-consumer content. none of these appear to be integral to the process of making linoleum, meaning that manufacturers presum- Linoleum is the only flooring that uses biobased con- ably could design processes that do not use or produce tent and the only one in which all of the products have any of the identified High Concern chemicals that are a significant amount of renewable content of any sort. currently used. Linoleum does have the extra burden of The biobased content is currently tarnished by the toxic some High and Very High Concern agricultural chemi- chemical usage in and eutrophication from the agricul- cals involved in the agricultural production of flax for tural system. This can, however, be changed. At least one linseed oil. These also are not integral to linoleum as linoleum manufacturer is working with the flax industry flax can be grown by organic methods that do not rely to improve agricultural practices to reduce these impacts. upon any high hazard chemicals. Some manufacturers Linoleum products all have a significant amount of are working to improve field techniques and move away recycled content, although it is post-industrial. from Very High Hazard chemicals in flax agriculture. Polyolefin, synthetic rubber and vinyl floorings gener- Polyolefin flooring manufacture is only known to use ally use little to no post-consumer recycled content. one High Concern carcinogenic chemical – form- Most of the recycled content used in PVC, SBR, and aldehyde – and given the wide range of formulas for Stratica-type polyolefin products is post-industrial, polyolefins, polyolefins may be redesigned to eliminate mostly waste scraps from their own production pro- formaldehyde exposures. There is an additional poten- cesses. Only a few SBR flooring products have signifi- tially significant but poorly understood cancer risk from cant quantities of post-consumer recycled content. The the potential ability of ethylene – which is integral content comes from vehicle tires that contain a wide to all three petroleum based materials – polyolefins, variety of toxicants. synthetic rubber and vinyl – to be metabolized into a carcinogen (ethylene oxide). End of life Synthetic rubber flooring made from SBR has several It is important to “close the loop” at the end of the life High Concern chemicals that are integral feedstocks to of a flooring product to bring it back as a recycled mate- the polymer. Therefore, while some of the High Con- rial or compost it back into the agricultural system. All cern chemicals used in manufacture could be removed of the materials studied are theoretically recyclable. through better design of the process, synthetic rubber Linoleum is theoretically compostable. But additives, flooring manufacture will only become free of high haz- adhesives, infrastructure and economics are major ard toxicants by development of new rubber polymers impediments to closing the loop for all of them. A not based upon styrene and 1,3-butadiene chemistry. few pilot projects are underway with vinyl, rubber and linoleum recycling, but the projects involve very small Vinyl flooring also has several High Concern feed- volumes. They take primarily job site waste, not end of stocks that are integral feedstocks to the polymer (eth- life waste, and are mostly presumed to be downcycled ylene dichloride, chlorine and vinyl chloride mono- (recycled into lesser uses). One linoleum manufacturer mer), plus the Very High Concern PBTs referenced is piloting a composting program for its products. The earlier. As with SBR, PVC has inherent problems with market has far to go to improve the end of life for floor- the chemistry of the polymer that make it impossible to ing products and none of the products has a significant create PVC that is free of high hazard toxicants, made advantage on this count at this time. worse by the addition of PBTs.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 33 Table 2. Chemicals of highest concern by exposure

Chemicals PVC SBR Stratica Linoleum Hazards Dioxins Intl POP, PBT, carcinogen, endocrine Polychlorinated biphenyls (PCBs) Int POP, PBT, carcinogen, developmental neuro, endocrine & aquatic Hexachlorobenzene (HCB) Int POP, PBT, carcinogen, neurotoxicant, developmental & aquatic Cadmium Opt PBT, carcinogen, developmental & reproductive & aquatic Mercury Opt Opt PBT, developmental neuro & endocrine Lead Opt Opt PBT, carcinogen, reproductive, developmental neuro & endocrine Chlorinated paraffins & decaBDE Opt Opt PBT, carcinogen & endocrine Persistent PBT s* PBT Persistent Polycyclic aromatic compounds Intl Opt POP, PBT, carcinogen Trifluran & other PBT pesticides Opt PBT, carcinogen Lead, cadmium, paraffins & decaBDE Opt Opt see Persistent exposures Butyl benzyl phthalate (BBP or BzBP) Opt Developmental & reproductive, endocrine & aquatic Di(2-ethylhexyl phthalate (DEHP) Opt Developmental, reproductive & endocrine Di-n-hexyl phthalate (DnHP) Opt Reproductive Tributyltin Opt endocrine Antimony trioxide Opt Opt Carcinogen Styrene Int Carcinogen (possible), endocrine, neuro Toluene, acetaldehyde and other VOCs Opt+ Opt Opt Opt Carcinogens, developmental & neuro

Contents- User exposures User Contents- Pigments (titanium dioxide & carbon black) Opt Opt Opt Opt Carcinogen through inhalation Ethylene dichloride (EDC) Intl Carcinogen Vinyl chlorine monomer (VCM) Intl Carcinogen & neuro Chlorine gas Intl Aquatic & acute 1,1,1-trichloroethane Int neurotoxicant and ozone depletor Acrylic acid ? acute Vinyl acetate Opt Opt Carcinogen (suspected) Mercury Opt Opt PBT, developmental & neuro Neuro & may metabolize to ethylene oxide (carcinogen & Ethylene Int Int Int reproductive) 1,3, butadiene Int Carcinogen, reproductive & developmental exposures** Acrylonitrile Opt Carcinogen & neuro Dimethylformamide Opt Reproductive & developmental Dithiocarbamates Opt Endocrine, neuro Ethylbenzene Int Carcinogen -Feedstocks & intermediary chemicals -Feedstocks or emissions Additional manufacturingor emissions Additional Benzene Int Opt Carcinogen, developmental & mutagen Formaldehyde Opt Opt Carcinogen

Epichlorohydrin Opt Carcinogen, reproductive, mutagen Bromoxynil, Trichlorfon, Mancozeb & other pesticides Opt Carcinogens, developmental toxicants, neuros & endocrines Fill colors in the table reflect the concern level in Table 1

Black = Very High Concern Red = High Concern Orange = Moderate Concern

* In addition to the chemicals listed, all three of the petrochemical plastics (PVC, SBR & polyolefin) share common PBT releases from the extraction and refining process of the petrochemical raw materials ** Manufacturing exposures also include all of the exposures from the persistent PBT & user exposure categories Int =integral – fundamental unavoidable part of the base material, not likely to be designed out of the chemical process without significant redesign. Opt=Optional variation on additives or manufacture process that is relatively more possible to avoid by selection or redesign. + Note that materials engineering can reduce, but not likely totally eliminate VOC emissions from any of these flooring types.

34 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care Table 3. Life Cycle Comparison of Flooring Material Types

PVC/Vinyl Synthetic Rubber Polyolefin Issues Reference (SBR) (Stratica) Linoleum

High, but ag Biobased None = None = None + practices need content improvement

Post consumer No PC, highest Some have but recycled Virtually none = None = PI (post ? may be toxic content industrial) Raw material material Raw Many – petrol- Many – petrol- Few – pesticides POPs, other Many in petroleum = eum extraction & = eum extraction + can be PBTs, CMRs extraction & refining refining & refining eliminated

Many, major dioxin POPs + None identified + None identified + None source

Many but may Many but may be able Other PBTs = be able to be + None identified ++ None to be designed out designed out

Manufacturing Few – all Many but may CMRs Many integral = Many integral + optional, ex ++ be able to ethylene eliminate all

Heavy metals Many but may Many but may be able & flame = be able to be ++ None ++ None to be designed out retardants designed out

Many but may be able Phthalates ++ None ++ None ++ None

Use Use to be designed out

Many. May Many. May Many. May Many. May reduce but VOC = reduce but not = reduce but not = reduce but not not eliminate eliminate eliminate eliminate

Small Recycling or Small experimental – None – None = experimental composting recycling composting

End of Life POPs Major dioxin source + None identified + None identified + None identified

Key: Comparison to vinyl

? Unclear – Worse = Similar + Better ++ Best

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 35 CONCLUSION AND VFUTURE. RESEARCH Not one of the materials reviewed is hazard free as cur- ing process. This review is based on just one product rently produced. The product types do, however, vary (Stratica) within the polyolefin family and without the considerably in the amount and extent and exposure of benefit of manufacturing emissions data. It will also be Very High Concern PBTs and High Concern chemicals necessary to obtain manufacturing emissions data for that are currently involved in the product life cycle. Stratica and assess other polyolefin products to confirm There are also distinct differences between the mate- the more preferable assessment of polyolefins. rials reviewed here with regard to the potential for manufacturers to further reduce the hazards. Synthetic rubber products have much room for improvement, but more significant inherent limita- For some products, there are a range of opportunities tions than polyolefins, making them less preferable on a for specifiers and purchasers to encourage manufac- chemical hazard basis. With several High Concern car- turers to reduce or eliminate the use and production cinogens playing key roles in synthetic rubber material of PBTs and other High Concern chemicals. With chemistry, they may be able to eliminate the PBTs from encouragement from the marketplace, some resilient manufacturing and end of life, but can never become flooring manufacturers could reformulate their flooring CMR-free. products to virtually eliminate the PBTs and CMRs from manufacture, use and disposal, so as not to expose Vinyl products have some room for improvement, but workers or users to PBTs, carcinogens, mutagens or are even more handicapped than SBR. With High reproductive toxicants. All of the fossil fuel-based Concern carcinogens and PBTs inherent in their manu- products, however, have a common burden of PBTs and facture and life cycle chemistry, PVC-based products other toxics from the extraction and refining process of can not, by definition eliminate the hazard of PBTs and the fossil fuels. CMRs from any part of the life cycle and are hence the least preferable of all the materials assessed. Linoleum has strong prospects for minimizing its already lower chemical hazard. Opportunities exist Closing the Loop: Flooring products have a long both in agricultural production and the manufacturing way to go on closing the material loop. While there processes. It should be technically possible to pro- are big differences in the recycled content available duce a product free of PBTs and CMRs, making this between the products studied, virtually none of them the most preferable product from a chemical hazard use significant quantities of post-consumer content. perspective, both in current practice and in likely Furthermore, the products with the most recycled or potential. Manufacturing emissions data is needed to biobased content today still have significant toxic verify the assessment. Furthermore it should be noted issues associated with those processes. There is plenty that manufacturing truly free of PBTs and CMRs can of need for specifiers and purchasers to encourage only be accomplished when the process is powered by manufacturers to increase use of renewable materials renewable energy sources (an issue common to all of that are free of PBTs and CMRs and to design for end the examined products). of life recycling or composting. None of the resilient flooring manufacturers utilizing the materials reviewed Polyolefins are the next preferable material – the most are close to closing the loop of material flow through preferable of the purely petrochemical-based products. recycling or composting for a significant percentage of While they share the toxics of the refining process with their production. In this area there are however, also the other petrochemical-based products, they appear to significant differences between the materials, both in be otherwise largely PBT-free. Problems with ethylene’s current practice and future potential. metabolites warrant further study and could limit the ability to get to a completely CMR-free manufactur-

36 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care All of the product types have demonstrated the poten- Many health care systems, including those profiled tial to recycle (or in the case of linoleum, to compost) in this paper, are effectively specifying and using the the product, but all face similar challenges in dealing alternative materials in new and renovated health care with the adhesives used for securing the products to facilities. Capturing and reporting on the experience the floor and in gathering product at the end of its life facilities have with these new materials and broadly and transporting it back to the factory for recycling. All sharing this information may assist in both wider adop- of the petrochemical products also have the inher- tion and product innovation. ent limitation that, due to wide variation in chemi- cal composition of additives, they can’t be mixed for The Research Collaborative intends to follow this recycling even with other products of the same plastic paper with a project to assess the installation and type, except for downcycling into lower grade products. performance challenges and benefits of the different Linoleum may have the highest potential here since it materials profiled here. Interviewing hospital staff, the can be composted with other materials if the adhesive study will explore a number of attributes of the alterna- issue can be solved. tive materials, including: r Durability; Energy and other environmental issues: This analysis r Safety – traction and effect on slips, trips and falls; focuses on chemical hazard-based human health r Glare; issues. There are many other issues that could be included in a full environmental analysis of resilient r Comfort, fatigue and strain; flooring. Embodied energy, carbon footprint and r Acoustics; corporate are just examples of r Installation, including analysis of both installation other important areas that warrant assessment but processes and toxic properties of adhesives and seal- that are beyond the scope of this paper. The Healthy ants recommended for use with the materials; Building Network’s Pharos Project will be developing r Time constraints; and analyses of these and other building products across a r Cleaning and maintenance. broader set of parameters, expanding to incorporate more categories of issues such as these. Many health care organizations are committed to eliminating products from their buildings that con- Next Steps: While no ideal “green” material currently tain chemicals that can harm patients, staff, and the exists for health care flooring options,Resilient Floor- environment. With greater awareness of the health ing & Chemical Hazards: A Comparative Analysis of issues associated with resilient flooring and the prod- Vinyl and Other Alternatives for Health Care illustrates ucts required to install and maintain them, health care the range of alternative materials which are preferable organizations and designers can make more informed to sheet and tile products made with PVC – posing decisions and collectively help move the market by fewer chemical hazards in their current formulations their specifications and purchasing power. In turn this and having more potential for further improvement. can reduce the hazardous chemicals introduced into Yet, hundreds of health care organizations continue to interior environments by the building materials and source PVC-based products for their facilities. Lack of promote a healthier healing environment. information about performance, lack of experience in cleaning and maintenance, and the slow pace of change in the health care industry all contribute to slowing the transformation of the industry to safer alternatives.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 37 APPENDIX A: REVIEW OF OTHER ACOMPARATIVE. STUDIES This appendix reviews a series of other studies that have disposal was a particularly important factor distinguish- compared health and other environmental impacts of ing health impacts of PVC from linoleum. Sheet vinyl some of the flooring materials assessed in this paper. performed worst overall on all other environmental A number of organizations have undertaken life cycle impact categories as well, except eutrophication. assessments (LCA) of the flooring material types evaluated in this paper. As opposed to the hazard- NIST BEES LCA: The U.S. National Institute of based approach, LCA studies work on a material flow Standards and Technology (NIST) has created a soft- approach. LCAs attempt to quantify all of the flows of ware package called BEES (Building for Environmental materials, energy and emissions that go into and out of and Economic Sustainability) that allows comparative the production, use and disposal of a product over its LCA analyses of a variety of building materials includ- life cycle. They then assign weights to the impacts of ing linoleum and VCT.177 BEES creates LCA scores for each of the material flows to try to make them compara- a range of environmental and human health impacts, ble. A full assessment of the strengths and weaknesses of and then combines them into a total score. At the the LCA approach is beyond the scope of this review.175 individual impact level BEES 3.0 ranked VCT equal or This review also includes one emission-based study. worse than linoleum in every category except eutrophi- cation, with VCT scoring anywhere from 1.4 to 8 times TURI Five Chemicals Alternatives Assessment worse than linoleum. Linoleum even outperformed Study: The Toxic Use Reduction Institute (TURI) VCT on fossil fuel depletion, despite the fact that lino- at the University of Massachusetts Lowell conducted leum is imported from Europe, while VCT is manufac- a study to assess safer alternatives for five chemi- tured in the US. Nonetheless, BEES 3.0 calculated that cals (lead, formaldehyde, perchloroethylene (PCE), linoleum’s eutrophication score outweighed all of the hexavalent chromium and di(2-ethylhexyl)phthalate others and gave it a worse overall score. (DEHP). It applied an alternatives assessment method- ology to evaluate alternatives in selected applications. Studies of the BEES protocol revealed numerous issues The study includes a section on resilient flooring which with that assessment. A Healthy Building Network addressed PVC plasticized with DEHP and a variety of (HBN) analysis of the BEES database revealed that the alternatives, including linoleum, cork and polyolefin BEES analysis did not account for dioxin releases from (studying the same single polyolefin studied in this manufacturing or end of life combustion. This omission paper). Product types are compared across a wide range biased the BEES analysis by leaving out the most impor- of factors of health, environment and performance. tant impact of the PVC life cycle.178 Industry represen- The three alternatives are similar or better than PVC tatives asserted that the eutrophication calculation was in almost every issue category. one or more orders of magnitude too high as well. The most current release of the BEES software (BEES 4.0e) U.S. Green Building Council TSAC LCA & Risk using new databases does now account for substantial Assessment: The U.S. Green Building Council dioxin flows from PVC manufacture. It still does not, (USGBC) Technical Science Advisory Committee however, account for end of life dioxin releases. None- (TSAC) carried out a comparative assessment of PVC theless in the new analysis, linoleum now comes out and a variety of alternative materials used in build- with far less environmental impact overall than VCT, ing materials, including vinyl and linoleum flooring primarily driven by a better human health score. (but not SBR or polyolefins).176 Using a combination of LCA and risk assessment, the study concluded that Fraunhofer LCA: The Environmental Building News has vinyl (both VCT and vinyl sheet) flooring performed reported that a Fraunhofer Institute life cycle compari- worse than linoleum on its measures of cancer and total son commissioned by Amtico compared Stratica and human health. The impact of dioxin emissions from vinyl flooring and concluded that the manufacture of

38 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care Stratica requires 30% less energy and 29% less water, carbons, many of them higher molecular weight alkyl- resulting in 33% less contribution to global warming substituted benzenes, including phenol. The study only and 54% less acidification.179 The authors attempted to addressed VOCs, not SVOCs, such as phthalates. obtain a copy of this study; however, the manufacturer informed us that it is unavailable in the United States. Summary PVC: These comparative studies, with limited excep- Gunther European manufacturer LCA: Fourteen tions, indicate that the health and environmental European producers of resilient floor coverings collabo- performance of vinyl flooring is equal to or worse than rated on an LCA study authored by Gunther in 1997 the other flooring types in the categories assessed. that compared floorings made with PVC, polyolefins, linoleum and SBR rubber.180 For most of the measures Synthetic rubber: Synthetic rubber – specifically compared, PVC performed either worst or second worst SBR – was only evaluated in one of the studies. In the amongst floor covering types. For chemical waste, PVC Gunther study it generally performed better than PVC was responsible for more than four times the waste than but not as well as linoleum or polyolefins. Synthetic from rubber and more than ten times the waste than rubber performed worst in one category – acidification from polyolefin or linoleum. PVC also required the most potential, due to sulfur emissions during vulcanization. non-renewable energy per unit of flooring. All of the products were roughly comparable for water demand Polyolefins/Stratica: Stratica and the polyolefins and municipal waste generated. Synthetic rubber per- generally performed well in the studies where it was formed worst in one category – acidification potential assessed. It should be noted, however, that it was due to sulfur emissions during vulcanization. PVC per- included in only two of the studies and neither was formed second worst in acidification with about half the independent. Both were sponsored by manufacturers. potential of rubber. Polyolefin and linoleum produced about half the acidification potential of PVC. Linoleum: Linoleum generally scored well in these studies, except for the eutrophication category, in Linoleum performed worst in this study in one category which it ranked worst in two studies. The magnitude of – global warming potential, with PVC second worst these results is a subject of some controversy, but it is a again. The study assumes that 100% of the linoleum generally acknowledged problem area for linoleum (and would be disposed of in a landfill and anaerobically any biobased product) and efforts are underway to rec- digested, creating methane. The calculation, however, tify the problem. The global warming impact associated fails to consider that a significant percentage of dis- with linoleum disposal in the Gunther study, described posed linoleum is burned in a waste incinerator instead above has not been reflected in other studies. of landfilling, replacing the highly potent methane global warming emissions with far less potent carbon dioxide emissions. It is also unclear whether the Euro- pean study accounted for the CO2 sequestered by the plants used as feedstock for the linoleum manufacture. Composting linoleum—a practice just now beginning to be undertaken—would also replace the methane emissions with carbon dioxide emissions.

Hodgson LBL emissions study: A team from the Lawrence Berkeley Laboratory at the University of California, Berkeley did laboratory measurements of VOC emissions from samples of a variety of interior finish products that are frequently used in relocatable classrooms. Products tested included vinyl composition tile (VCT), sheet vinyl, and an unspecified chlorine- free tile resilient flooring alternative.181 The VOC emissions from the VCT and the chlorine-free tile contained only a few compounds at detectable levels. The emissions from the sheet vinyl flooring, however, contained a relatively large number of aromatic hydro-

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 39 APPENDIX B: BCHEMICAL. HAZARD LISTS All chemical hazard lists screened for the analysis in this Persistent, Bioaccumulative and Toxic (PBT) sub- paper are listed below with any categories used in the stances include very Persistent and very Bioaccumula- list to differentiate hazard types and confidence levels. tive (vPvB), very Persistent and Toxic (vPT) and very The parenthetic abbreviation before the list title is the Bioaccumulative and Toxic (vBT). abbreviation used for reference to this list in Table 4 below which cross-references the chemicals identified Note that governmental bodies are still in the process in the text to any chemical hazard lists where they have of developing authoritative lists for neurotoxicity and been identified. The square bracketed phrase indicates endocrine disruption. Due to the importance of these the level of concern assigned in the analysis framework endpoints, we have incorporated a list for each of these for this study and the chemical characteristic or health developed with peer review from surveys of the scien- endpoint associated with that list or list category. tific literature.

r (CA Prop65) California Proposition 65 (Safe Drinking Water and Toxic Enforcement Act Of 1986) Chemicals Known to the State to Cause Cancer or Reproductive Toxicity A. “cancer” [High concern – carcinogen] B. developmental” [High concern – development] C. “male” (reproductive) [High concern – reproductive] D. “female” (reproductive) [High concern – reproductive] State of California Environmental Protection Agency, Office of Environmental Health Hazard Assessment (OEHHA) – Source: http://www.oehha.ca.gov/prop65/prop65_list/Newlist.html

r (EC CMR) Carcinogens, Mutagens, & Toxic for Reproduction – See consolidated version of Annex I of Directive 76/769 EEC, which includes Annex I of Directive 65/548/EEC (which is to be replaced by Annex XVII of REACH on 1 June 2009) point 29. A. Carcinogen Category 1: “known” [High concern – carcinogen] B. Carcinogen Category 2: “should be considered carcinogenic to humans” [High concern – carcinogen] C. Mutagen Category 1: “Substances known to be mutagenic to man” [High concern – mutagen] D. Mutagen Category 2: “Substances with should be regarded as if they are mutagenic to man” [High concern – mutagen] E. Reproduction category 1: “known” to impair fertility in humans or cause developmental toxicity in humans” [High concern – reproduction] F. Reproduction category 2: “should be regarded as if” they impair fertility to humans or cause developmental toxicity to humans” [High concern – reproduction] European Commission, Enterprise and Industry DG Source: http://ec.europa.eu/enterprise/chemicals/legislation/markrestr/index_en.htm

r (EC ESIS} European Chemical Substances Information System (ESIS) PBT list A. Fulfilling PBT criteria[Very high concern – PBT] B. Fulfilling POP criteria[Very high concern – PBT]

40 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care C. Fulfilling vPvB criteria[Very high concern – PBT] European Commission, Joint Research Centre, Institute for Health & Consumer Protection Source: http://ecb.jrc.it/esis/index.php?PGM=pbt r (EC Risk) Substances with EU Risk & Safety Phrases (Commission Directive 67-548-EEC) A. R45 “May cause cancer” [High concern – carcinogen] B. R46 “May cause heritable genetic damage” [High concern – mutagen] C. R49 “May cause cancer by inhalation” [High concern – carcinogen] D. R60 “May impair fertility” [High concern – reproduction] E. R61 “May cause harm to the unborn child” [High concern – reproduction] F. R63 “Possible risk of harm to the unborn child” [Moderate concern – reproduction] Joint Research Centre (DG JRC), Institute for Health and Consumer Protection (IHCP) Source: http://ecb.jrc.it/documentation/ (click on: “DOCUMENTS”, “CLASSIFICATION-LABELLING”, “DIRECTIVE 67-548-EEC”, “ANNEX I OF DIRECTIVE 67-548-EEC”, and then either of the files listed as: “Annex I of Directive 67548EEC”) r (EPA IRIS} Integrated Risk Information System database 1. 2005 Guidelines: A. “Carcinogenic to humans” [High concern – carcinogen] B. “Likely to be carcinogenic to humans” [High concern – carcinogen] C. “Suggestive evidence of carcinogenic potential” [Moderate concern – carcinogen] D. “Unknown cancer” [Moderate concern] 2. 1999 Guidelines: A. “Carcinogenic to humans” [High concern – carcinogen] B. “Likely to be carcinogenic to humans” [High concern – carcinogen] C. “Suggestive evidence of carcinogenicity, but not sufficient to assess human carcinogenic potential” [Moderate concern – carcinogen] D. “Unknown cancer” [Moderate concern – carcinogen] 3. 1996 Guidelines: A. “Known/likely human carcinogen” [High concern – carcinogen] B. “Unknown cancer” [Moderate concern – carcinogen] 4. 1986 Guidelines: A. Group A – Human Carcinogen” [High concern – carcinogen] B. “Group B1 – Probable human carcinogen – based on limited evidence of carcinogenicity in humans and sufficient evidence of carcinogenicity in animals”[High concern – carcinogen] C. “Group B2 – Probable human carcinogen- based on sufficient evidence of carcinogenicity in animals)” [High concern – carcinogen] D. Group C – “Possible human carcinogen” [Moderate concern – carcinogen] E. Group D – “Not classifiable as to human carcinogenicity”[Moderate concern – carcinogen] U.S. Environmental Protection Agency (EPA), USEPA National Center for Environmental Assessment Source: http://www.epa.gov/ncea/iris/search_human.htm r (EPA NWMP) NWMP PBT Priority Chemicals List. [Very high concern – PBT] U.S. Environmental Protection Agency, National Waste Minimization Program Source: http://www.epa.gov/epawaste/hazard/wastemin/priority.htm

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 41 r (EPA PPT) Priority PBT Profiles [Very high concern – PBT] U.S. Environmental Protection Agency, Pollution Prevention & Toxics, Persistent Bioaccumulative and Toxic Chemical Program – Source: http://www.epa.gov/opptintr/pbt/pubs/cheminfo.htm

r (EPA TRI) PBT Chemical List, [Very high concern – PBT] U.S. Environmental Protection Agency, Toxic Release Inventory Program Source: http://www.epa.gov/triinter/trichemicals/pbt%20chemicals/pbt_chem_list.htm

r (IARC) Agents Reviewed by the IARC Monographs A. Group 1: Agent is carcinogenic to humans [High concern – carcinogen] B. Group 2A: Agent is probably carcinogenic to humans [High concern – carcinogen] C. Group 2b: Possibly carcinogenic to humans [Moderate concern – carcinogen] International Agency for Research on Cancer – Source: http://monographs.iarc.fr/ENG/Classification/

r (Lancet) List of 201 Chemicals known to be neurotoxic in man. A. Developmental neurotoxicant – [High concern – developmental neurotoxicant] B. Neurotoxicant – [Moderate concern – neurotoxicant] “Developmental neurotoxicity of industrial chemicals” Grandjean, P & PJ Landrigan. 2006, The Lancet, v.368: 2167-2178 Source: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)69665-7

r (NTP ROC) Report on Carcinogens C. Known to be Human Carcinogens [High concern – carcinogen] D. Reasonably Anticipated to be Human Carcinogens [High concern – carcinogen] U.S. National Institutes of Health, National Institute of Environmental Health Sciences, National Toxicology Program (NTP) – Source: http://ehis.niehs.nih.gov/roc

r (OSF) Widespread Pollutants with Endocrine-disrupting Effects List and r Background Information on Common Endocrine-Disrupting Compounds [High concern – endocrine disruptor] Our Stolen Future authors Dr. Theo Colburn, Dianne Dumanoski, and Dr. John Peterson Myers Source: http://www.ourstolenfuture.org/Basics/chemlist.htm http://www.ourstolenfuture.org/Basics/chemuses.htm

r (WA PBT) Chapter 173-333 WAC Persistent Bioaccumulative Toxins (PBT) List [Very high concern – PBT] State of Washington, Department of Ecology – Source: http://apps.leg.wa.gov/WAC/default.aspx?cite=173-333-310

r (UN POP) List of 12 POPs currently under the Stockholm Convention – [Very high concern – PBT] United Nations Environment Programme (UNEP), Stockholm Convention Secretariat Stockholm Convention on Persistent Organic Pollutants (POPs) Source: http://chm.pops.int/Convention/12POPs/tabid/296/language/en-US/Default.aspx

r (UN POPRC) Chemicals in the Stockholm Convention POPRC review process – [High concern – PBT] United Nations Environment Programme (UNEP), Stockholm Convention Secretariat Stockholm Convention on Persistent Organic Pollutants (POPs) Source: http://chm.pops.int/Convention/POPsReviewCommittee/tabid/60/language/en-US/Default.aspx

42 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care Table 4: Resilient Flooring Chemical Listings on Hazard Databases

Chemicals CAS No 65 CA Prop EC CMR EC ESIS EC Risk IRIS EPA NWMP EPA PPT EPA TRI EPA IARC Lancet NTP ROC OSF UNPOP UNPOPRC PBT WA 1,3, butadiene 106-99-0 XX XX X X 1,1,1-trichloroethane 71-55-6 X X Acetaldehyde 75-07-0 X X X X Acrylic acid 79-10-7 X Acrylonitrile 107-13-1 XX XX X Antimony trioxide 1309-64-4 X X X Asbestos 1332-21-4 XXXX Benzene 71-43-2 XX X X Benzo(g.h.l)perylene 191-24-2 X X X Bromoxynil 1689-84-5 X Butyl benzyl phthalate (BBP or BzBP) 85-68-7 XX XX X Cadmium 7440-43-9 X XXX X X Carbon black (pigment) 1333-86-4 X X Chlorinated paraffins 85535-84-8 X XX X XX Chlorine 7782-50-5 X decaBDE 1163-19-5 X XX X Di(2-ethylhexyl phthalate (DEHP) 117-81-7 XX XX XX Dimethylformamide 68-12-2 XX Di-n-hexyl phthalate (DnHP) 84-75-3 X Dioxins 1746-01-6 X XXXX XXX X Dithiocarbamates Multiple X Epichlorohydrin 106-89-8 XX X X X Ethylbenzene 100-41-4 X X Ethylene 74-85-1 X Ethylene dichloride (EDC) 107-06-2 X X X Ethylene oxide 75-21-8 XX X XXX Formaldehyde 50-00-0 X X X X Hexachlorobenzene (HCB) 118-74-1 X XX X XXX XX X X Lead 1-12-8 X XXXXXXXX X Mercury 7439-97-6 X X XXX X X PFOS 29457-72-5 X Polychlorinated biphenyls (PCBs) 1336-36-3 X XX X XXX XXXX X Polycyclic aromatic compounds 65996-93-2 X X X X X Styrene 100-42-5 XX X Titanium dioxide 13463-67-7 X Toluene 108-88-3 X X X Tributyltin 688-73-3 X Trichlorfon 52-68-6 X Trifluran 1582-09-8 XXX X X Vinyl acetate 108-05-4 X Vinyl chloride 75-01-4 X X X XXX Zinc 7440-66 X

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 43 CAPPENDIX. C: PVC AND DIOXIN Dioxins are created in the manufacture of PVC during precision of the estimate is low. The estimate should be ethylene dichloride (EDC)/vinyl chloride monomer used for indicating approximate magnitude, not precise (VCM) production, released by on-site incinerators, amount. Directly measuring total actual emissions from flares, boilers, waste water treatment systems and even a diffuse underground fire in a landfill is nearly impos- in trace quantities in vinyl resins. EDC/VCM produc- sible and requires substantial sampling and modeling tion for PVC is one of the top well-quantified sources to estimate. Nonetheless, the EPA’s estimate of the of dioxin in U.S. EPA’s Inventory of Sources and likely magnitude of the emissions from landfill fires is Releases of Dioxin (number 8 for 2000) and is the larg- far larger than that from burn barrels. There is signifi- est source of dioxins in the Inventory that is specific cant evidence that PVC is the leading source of dioxin to the manufacture of a building material.182 The EPA releases from these landfill fires.186 Inventory number estimates only the fugitive and stack air emissions and water emissions directly from The same EPA Inventory also characterizes forest fires manufacturing plants. Far more dioxin is generated as another low confidence, but potentially even larger in the manufacturing process than is identified in the source of dioxins. Currently used estimates of forest fire EPA Inventory. The chlorine industry as a whole (of emission factors are likely high by an order of magni- which PVC manufacture is a major portion) reported tude or more due to confounding factors in the studies in its Toxic Release Inventory (TRI) data that it sent utilized. There is significant evidence that dioxin emis- 20 times more dioxin (260 g TEQ*) in heavy ends, sion rates from forest fires are actually not very signifi- tars and other hazardous materials to landfills and cant and that much of what emits from them may be injection wells in 2000 as it did to the air and water, due to re-suspension of dioxin from industrial sources only 100 g TEQ of which went to hazardous waste that was previously filtered out of the atmosphere by landfills.183 Another 810 g TEQ was transferred to “off the trees.187 site management,” some incinerated, some landfilled, some unspecified.184 Finally a massive 6900 g TEQ are “treated on and off site,” most commonly in hazardous waste incinerators.185

The EPA’s Inventory estimate of the likely magnitude of the emissions from landfill fires is substantial at 1,126 TEQ. This is over twice the size of the next largest source – backyard barrel burning, which is estimated at 498.5 TEQ. Burn barrel sources are frequently identi- fied as “the largest source” of dioxins because of confu- sion about the organization of the EPA Inventory lists. The listing most frequently referenced is Table 1-12 of the Inventory, a table which lists the EPA’s ranking of “well-quantified sources.” “Well quantified sources” are those for which EPA has a relatively high level of con- fidence in its estimate. Landfills fires are not included in this table because the EPA’s confidence level in the

* TEQ is “toxic equivalents” – a measure of the toxicity of a mixture of dioxins adjusted for the equivalent weight of the most toxic form of dioxin, 2,3,7,8-TCDD

44 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care APPENDIX D: DCOMPOSITION. OF STRATICA Patents188 and a Swedish product content declaration189 r Backing of either: filed by Amtico, the manufacturer of Stratica, indi- 9 Trimethylolpropane trimethacrylate (TMPTMA cate the flooring contains the following ingredients,190 – CAS 3290-92-4) from Methyl Acrylate (CAS # roughly in order of quantity: 96-33-3) or 9 Trimethylolpropane (TMP – CAS 77-99) r mineral fillers make up one third to one half and may be any one or more of the following r Lotader 4700 (ethylene/acrylic ester/maleic anhy- 9 calcium carbonate (CAS 471-34-1) dride terpolymer binder resin, 9 kaolin (CAS 1332-58-7) 9 hydrated aluminum oxide (CAS 21645-51-2) r Polymer binder of either 9 ethylene/maleic anhydride terpolymer (trade r ethylene/methyl acrylate resin (CAS 25103-74-6) – name Lotader CAS 41171-14-6 100% by weight, trade name Lotryl 18MA02 also known as ethylene/ 2-propenoic acid, ethyl ester, polymer with eth- methacrylate copolymer, propenoic acid, methyl ane and 2,5-furandione (maleic anhydride CAS ester, polymer with ethane191 108-31-6).193 9 ethylene vinyl acetate (EVA – CAS 24937-78-8). r ethylene/methacrylic acid copolymer (E/MAA, trade name Surlyn 9910 CAS 9078-96-0) r Pigments 9 zinc compounds (CAS 7440-66-6); added to E/ MAA as an acid neutralizer MAA is made from Isobutylene (CAS 115-11-7) and tert-butanol (CAS 75-65-0, oxidized into methacrolein (CAS 78-85-3) and then into MAA192

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 45 REFERENCES

1. NIOSH Safety and Health Topic: Engineering Controls. hexachlorocyclohexane, Short-chained chlorinated paraffins National Institute of Occupational Safety and Health (UN POP). (NIOSH). http://www.cdc.gov/niosh/topics/engcontrols. 14. Highlights of the 1990 Clean Air Act. Environmental Accessed March 30, 2009. Protection Agency Journal . http://www.epa.gov/history/ 2. “Pollution Prevention Concepts and Principles; National topics/caa90/01.htm. 1991. Accessed April 13, 2009; REACH Pollution Prevention Center for Higher Education, University Substances of Very High Concern, European Chemicals of Michigan. http://www.umich.edu/~nppcpub/resources/ Agency, Candidate List of Substances of Very High Concern GENp2.pdf;.1995. Accessed April 13, 2009. for authorization, http://echa.europa.eu/chem_data/candidate_ 3. Precautionary Principle. Science and Environmental Health list_table_en.asp . Accessed 4/19/2009. Kid Safe Chemicals Network. http://www.sehn.org/precaution.html. Accessed Act Of 2005 (Lautenberg) The Kid Safe Chemicals Act, February 10, 2009. Analysis By The Children’s Environmental Health Network , http://www.cehn.org/cehn/chemicals%20&%20Vccep/ 4. Wastewise Update – Moving Toward Sustainability United kidsafechemicalbill2005.htm July 2005. Accessed 4/19/2009 States Environmental Protection Agency, Solid Waste and Emergency Response (5306W), EPA530-N-00-002. http:// 15. Environmentally Preferable Purchasing Policy, Kaiser www.epa.gov/epawaste/partnerships/wastewise/pubs/wwupda13. Permanente. Healthy Building Network. http://www. txt. 2000. Accessed April 13, 2009. healthybuilding.net/healthcare/KaiserPermanente-EPP-Policy. pdf. 2008. Accessed April 13, 2009. 5. Adapted from Toxic Chemicals in Building Materials An Overview for Health Care Organizations. Healthy Building 16. Rossi M., Heine L., The Green Screen for Safer Chemicals Network in conjunction with Kaiser Permanente. 2008. http:// Version 1.0; Clean Production Action, January 2009, http:// www.healthybuilding.net/healthcare/Toxic%20Chemicals%20 www.cleanproduction.org/library/cpa-fact%20grscreen_Jan09_ in%20Building%20Materials.pdf. Accessed April 13, 2009. final.pdf. Accessed April 13, 2009. 6. Commoner B, Bartlett P, Eisl H, Couchot K. Long-range Air 17. 2007 Toxics Release Inventory (TRI) Public Data Release Transport of Dioxin from North American Sources to Ecologically Brochure., U.S. Environmental Protection Agency (U.S. Vulnerable Receptors in Nunavut, Arctic Canada: Final Report to EPA). http://epa.gov/tri/tridata/tri07/brochure/brochure.htm. the North American Commission for Environmental Cooperation.. Accessed April 13, 2009. U.S. facilities reported disposal or Diane Publishing Company; 2000. other releases in 2007 of over 4 billion pounds of the chemicals covered by the Toxic Release Inventory program. 7. Blais J M. Biogeochemistry of persistent bioaccumulative toxicants: processes affecting the transport of contaminants to 18. Environmental Inequality: Assessing the Evidence. Scorecard. remote areas. Can. J. Fish. Aquatic. Sci., 2005; Vol. 62 (1): 236- http://www.scorecard.org/env-releases/def/ej_evidence.html. 243. http://pubs.nrc-cnrc.gc.ca/rp/rppdf/f04-226.pdf. Accessed Accessed 3/23/2009. For a compilation of research studies on April 13, 2009. disparities in pollution impacts by income. 8. Centers for Disease Control and Prevention. Third National 19. FloorScore certification program. Scientific Certification Report on Human Exposure to Environmental Chemicals. Systems. http://www.scscertified.com/ecoproducts/ Atlanta (GA). http://www.cdc.gov/exposurereport/report.htm; indoorairquality/floorscore.html. Accessed April 13, 2009. 2005. Accessed April 13, 2009. 20. GREENGUARD Product Emission Standard For Children & 9. Stockholm Convention on Persistent Organic Pollutants. Schools. GREENGUARD. http://www.greenguard.org/Default. United Nations Environment Programme (UNEP). Stockholm aspx?tabid=110 . Accessed April 13, 2009. Note that there Convention Secretariat (Stockholm Convention). http://chm. is another GEENGUARD program called “GREENGUARD pops.int. Accessed April 13, 2009. Indoor Air Quality Certified” which uses a less stringent standard than the Children & Schools standard. 10. Aarhus Protocol on Persistent Organic Pollutants (1998); Oslo Paris (OSPAR) Convention (for the Protection of the Marine 21. CHPS Low-Emitting Materials (LEM) Table. Collaborative Environment of the North-East Atlantic) List of Chemicals for for High Performance Schools (CHPS). http://www.chps.net/ Priority Action; Stockholm Convention on POPs, Ibid. manual/lem_table.htm. Accessed April 13, 2009. 11. Fact sheet on Multimedia Strategy For Priority Persistent, 22. Toluene. See Table 4, Appendix B. Bioaccumulative, and Toxic (PBT) Chemicals. Persistent 23. Godish, T. Sick Buildings: Definition, Diagnosis, and Mitigation, Bioaccumulative and Toxic (PBT) Chemical Program. http:// CRC Press; 1995. www.epa.gov/pbt/pubs/fact.htm. Accessed February 10, 2009. 24. Standard Practice for the Testing of Volatile Organic 12. 1998 Memorandum of Understanding (MOU) between the Emissions from Various Sources Using Small-Scale American Hospital Association (AHA) and the U.S. EPA. Environmental Chambers (CA/DHS/EHLB/R-174). http://www.h2e-online.org/docs/h2emou101501.pdf. Accessed California Department of Health Services. http://www. April 13, 2009. cal-iaq.org/VOC/Section01350_7_15_2004_FINAL_PLUS_ 13. Chemicals in the POPs treaty include Hexachlorobenzene, ADDENDUM-2004-01.pdf. 2004. Accessed April 13, 2009. PCBs, Mirex, Aldrin, Chlordane, Dieldrin, Endrin, 25. Cho Y, Park, D, Kwon S. Characterization of voc emissions Heptachlor, Toxaphene, Dioxins, Furans and from interior materials of railroad passenger cabin and Dichlorodiphenyltrichloroethane (DDT). Chemicals preparation of environment-friendly interior material, under review that have been proposed for addition are: Environment & Fire Control Research Team, Korea Railroad pentabromodiphenyl ether, Chlordecone, Hexabromobiphenyl, Research Institute, Uiwang, Korea. http://www.inive.org/ Lindane, PFOS, octabromodiphenyl ether, members_area/medias/pdf/Inive%5CIAQVEC2007%5CCho_2. Pentachlorobenzene, Alpha-hexachlorocyclohexane, Beta- pdf. Accessed April 13, 2009.

46 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 26. The Pharos Project. Healthy Building Network. www. Alaee M. Arias P. Sjodin A, et al. An overview of commercially healthybuilding.net. Accessed April 13, 2009. used brominated flame retardants, their applications, their use 27. Meikle, J. American Plastic: A Cultural History, Rutgers patterns in different countries/ regions and possible modes of University Press. 1997. release. Environ. Int. 2003; 29(6):683-689. http://www.ncbi. nlm.nih.gov/pubmed/12850087 (abstract only). Accessed 28. Ackerman F, Massey R., The Economics of Phasing Out April 13, 2009. PVC. Global Development and Environment Institute, Tufts University. http://www.ase.tufts.edu/gdae/Pubs/rp/Economics_ 42. Ikonomou M, Rayne S, Addison R. Exponential increases of of_PVC_revised.pdf. 2003, revised 2006. Accessed April 13, the brominated flame retardants, polybrominated diphenyl 2009. ethers, in the Canadian Arctic from 1981 to 2000. Environ. Sci. Technology (2002);36:1886–1892. http://pubs.acs.org/doi/ 29. How is Vinyl Made? Vinyl Institute. http://www.vinylinfo.org/ abs/10.1021/es011401x (abstract only). Accessed April 13, WhatIsVinyl/HowisVinylMade.aspx. Accessed February 28, 2009. 2009. 43. de Boer J, Wester P, Klamer H, et al. Do flame retardants 30. Vinyl Flooring. e-vinylflooring.com. http://www.e-vinylflooring. threaten ocean life? Nature. 1998;394:28-29. http://www. com/. Accessed April 13, 2009. BEES 4.0 lists the constituents nature.com/nature/journal/v394/n6688/abs/394028a0.html of vinyl composition tile as 84% limestone, 12% vinyl resins (abstract only). Accessed April 13, 2009. (5% vinyl acetate, 95% vinyl chloride), and 4% plasticizers (60% BBP / 40% DINP). (BEES 2007) Barbara Lippiatt, BEES 44. Janssen S, Brominated Flame Retardants: Rising Levels of 4.0, Building for Environmental and Economic Sustainability: Concern. Health Care Without Harm. http://www.noharm.org/ Technical Manual and User Guide. National Institute of details.cfm?type=document&id=1095. 2004. Accessed April Standards and Technology, U.S. Dept. of Commerce. August 13, 2009. 2007. 45. Costner P, Thorpe B, McPherson A. Sick of Dust: Chemicals 31. Dioxins. See Table 4, Appendix B. in Common Products—A Needless Health Risk in Our Homes. Clean Production Action. http://safer-products.org/downloads/ 32. See UN POP in Appendix B, Dust%20Report.pdf. 2005. Accessed April 13, 2009. 33. AHA, HCWH, EPA MOU. Op. cit. 46. Sonya R, Caroline A. Mother’s Milk: Toxic Fire Retardants 34. Why Health Care is Moving Away from PVC. Health (PBDEs) in Human Breast Milk. Environmental Working Care Without Harm. http://www.noharm.org/details. Group. http://www.ewg.org/reports/mothersmilk. 2003. cfm?ID=1277&type=document. 2006. Accessed April 13, Accessed April 13, 2009. 2009. 47. Hoh E, Zhu L, Hites R. Dechlorane plus, a chlorinated flame 35. Resin Review. American Plastics Council. 2002. retardant in the great lakes. Environ Science Technol. 2006; 36. Borruso A. Polyvinyl Chloride Resins, Chemical Economics 40(4):1184-1189. http://www.precaution.org/lib/dechlorane_ Handbook. SRI Consulting. http://www.sriconsulting.com/ plus_in_great_lakes.060601.pdf. Accessed April 13, 2009. CEH/Public/Reports/580.1880/. 2006. Accessed April 13, 48. Antimony Trioxide. See Table 4. Appendix B. 2009. See also, Jebens A, Kishi A. Polyvinyl Chloride (PVC) 49. Waste Analysis Sheet: Heavy Ends from the distillation of Resins. Chemical Economics Handbook. 2001. Ethylene Dichlorine in Ethylene Dichloride Production. Dow In 1999, the total of all construction materials used, including Chemical. Plaquemine, LA. 1990. building wire, exceeded 10,700 million pounds, 75% of the 50. Polychlorinated biphenyls and hexachlorobenzene. See Table 14,200 million pounds used that year. Quantities are for 4, Appendix B. consumption of domestic production, not including imports. Just over half of the construction related consumption was for 51. Mercury See Table 4. Appendix B. pipe and tubing. 52. Winalski D, Mayson S, Savitz J. Poison plants: chlorine 37. Coaker W. Fire and flame retardants for PVC.J. Vinyl Additives. factories are a major global source of mercury. Oceana. http:// Technol. 2004;9(3):p. 108. www.oceana.org/north-america/publications/reports/poison- plants-a-report-on-the-chlorine-industry/. 2005. Accessed 38. Grand A, Wilkie C. Fire Retardancy of Polymeric Materials. April 13, 2009. CRC Press; 2000, p.277. http://books.google.com/ books?id=BOIlen8ZqP4C. Accessed April 13, 2009. The 53. Chlor-Alkali Plants Using Mercury Cell Technology. Mercury Chlorinated Sector Group: Major Applications. EuroChlor. Contamination in Fish: A Guide to Staying Healthy and http://www.eurochlor.org/chlorinatedparaffinsapplications Fighting Back. National Resources Defense Council. http:// Accessed February 29, 2009. www.nrdc.org/health/effects/mercury/chlor-alkali.asp. Accessed March 9, 2009. 39. Chlorinated paraffins. See Table 4, Appendix B. 54. Lead. See Table 4. Appendix B. 40. Adapted from Toxic Chemicals in Building Materials An Overview for Health Care Organizations. Healthy Building 55. Cadmium. See Table 4. Appendix B. Network in conjunction with Kaiser Permanente. 2008. 56. Tributyltin. See Table 4. Appendix B. 41. Mazdai A, Dodder N, Abernathy M, Hites R, Bigsby R. 57. Polycyclic aromatic compounds. See Table 4. Appendix B. Polybrominated diphenyl ethers in maternal and fetal blood 58. Wang D, Piao M, Chu S,, et al. Chlorinated polycyclic samples. Environmental Health Perspectives. 2003;111(9):1249- aromatic hydrocarbons from polyvinyl chloride combustion. 1252. http://www.ehponline.org/members/2003/6146/6146.html; Environ. Contam. Toxicology. 2001;66(3): 326-333. http://www. Ilonka A, Meerts T, van Zanden J, Luijks E, et al. Potent springerlink.com/content/buk323qrjtmt225v/ (preview only). competitive interactions of some brominated flame retardants 59. Shea K. Pediatric Exposure and Potential Toxicity of Phthalate and related compounds with human transthyretin in Plasticizers. Technical Report. American Academy of vitro. Toxicology. Science 2000:56:95–104. http://toxsci. Pediatrics. PEDIATRICS 2003; 111(6): 1467-1474. http:// oxfordjournals.org/cgi/content/full/56/1/95. Accessed April 13, pediatrics.aappublications.org/cgi/content/full/111/6/1467. 2009; and Accessed April 13, 2009.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 47 60. Rudel RA, Camann DE, Spengler JD, et al. Phthalates, ehponline.org/members/2008/10846/10846.pdf. Accessed alkylphenols, pesticides, polybrominated diphenyl esters and April 13, 2009. other endocrine-disrupting compounds in indoor air and dust. 71. Stahlhut R, Wijngaarden E, Dye T, Cook S, Swan S. Environ. Sci. Technol. 2003;37(20):4543-4553. http://www. Concentrations of urinary phthalate metabolites are associated ncbi.nlm.nih.gov/pubmed/14594359 (abstract only). Accessed with increased waist circumference and insulin resistance in April 13, 2009; and Sick of Dust. Clean Production Action. adult U.S. males. Environmental. Health Perspectives. 2007; Op. cit. 115(6):876-882, including erratum. http://www.ehponline.org/ 61. Hine E. Calafat A, Silva M, et al. Concentrations of members/2007/9882/9882.pdf. Accessed April 13, 2009. (See phthalate metabolites in milk, urine, saliva, and serum of also: http://impact_analysis.blogspot.com/2007/03/phthalates- lactating North Carolina women. Environmental Health and-obesity.html.) Perspectives. 2009;117 (1):86-92. http://www.ehponline.org/ 72. BEES 2007. Op. cit. members/2008/11610/11610.html. Accessed April 13, 2009; and 73. Floyd/Snider. Sediment Phthalates Work Group Meeting Body Burden: Phthalates. Environmental Working Group. Notes. January 31, 2007. http://www.ecy.wa.gov/programs/TCP/ http://www.ewg.org/featured/227. Accessed April 13, 2009; smu/phthalates/Sources.pdf. Accessed April 13, 2009. and Blount BC. Silva M, Caudill S, et al. Levels of seven urinary phthalate metabolites in a human reference population. 74. Sick of Dust. Clean Production Action. Op. cit. Environmental. Health Perspectives. 2000;108(10):979-982. 75. Carbon black. See Table 4. Appendix B. http://www.ehponline.org/members/2000/108p972-982blount/ 76. Titanium dioxide. See Table 4. Appendix B. blount.pdf. Accessed April 13, 2009. 77. Bjorseth O, Bakke J, Iversen N, Martens B. Characterization 62. Booker S, Claudio. NIEHS investigates links between of emissions from mechanical polishing of PVC floors. Swedish children, the environment, and neurotoxicity. NIEHS News. Environmental Research Institute Ltd. http://www.nyf.no/ Environmental. Health Perspectives. 2001; 109(6):A258-A261. bergen2002/papers/abstracts/L-abstr.pdf. Accessed April 13, http://www.ehponline.org/docs/2001/109-6/niehsnews.html. 2009. Accessed April 13, 2009; and Flooring: A quiet revolution dependent on phthalate plasticisers. Phthalates Information 78. Boehland J. Floorcoverings: Including Maintenance in Centre. http://www.phthalates.com/index.asp?page=13. the Equation. Environmental Building News. http://www. Accessed February 29, 2009. Major phthalates used in flooring buildinggreen.com/auth/article.cfm/2003/5/1/Floorcoverings- include butyl benzyl phthalate (BBP or BzBP), Di(2-ethylhexyl Including-Maintenance-in-the-Equation/. 2003;12(5). Quoting phthalate (DEHP), (DINP), Di-n-hexyl Norris G, et al. Indoor exposure in life cycle assessment: a phthalate (DnHP), and diisoheptyl phthalate (DIHP). See flooring case study- life cycle assessment. Harvard School of Table 4. Appendix B. Public Health. Unpublished paper. 2003. 63. Gray LE, Ostby J, Furr J, et al. Perinatal exposure to the 79. Ethylene. Table 4. Appendix B. phthalates DEHP, BBP, and DINP, but Not DEP, DMP, or 80. Törnqvist MA. Is ambient ethene a cancer risk factor? DOTP, alters sexual differentiation of the male rat. Toxicology. Environmental. Health Perspectives, 1994;102(4). http://www. Sci. 2000; 58:350-365. http://toxsci.oxfordjournals.org/ ehponline.org/realfiles/members/1994/Suppl-4/tornqvist-full. cgi/content/abstract/58/2/350. Accessed April 23, 2009. html. Accessed April 13, 2009; Törnqvist MA, Almberg JG, Diisononyl phthalate (DINP), Di-Isodecyl phthalate (DIDP) Bergmark EN, Nilsson S, Osterman-Golkar SM. Ethylene and diisoheptyl phthalate (DIHP) have no hazard warnings oxide doses in ethene-exposed fruit store workers. Scand J Work associated with them yet on the surveyed lists. DINP, however Environ Health.1989; 15(6). Granath F, Rohlén O, Göransson has already been implicated as a developmental toxicant in C, Hansson L Magnusson A-L, Törnqvist M. Relationship animal studies. between dose in vivo of ethylene oxide and exposure to 64. Butyl benzyl phthalate (BBP or BzBP). See Table 4. Appendix ethene studied in exposed workers. Hum Exp Toxicology. 1996; B. 15(10):846-854. Walker. Op, cit. Ethylene can be metabolized into ethylene oxide in plastic industry workers and others. 65. Di(2-ethylhexyl phthalate (DEHP) Table 4. Appendix B. Ethylene oxide Table 4. Appendix B. 66. Di-n-hexyl phthalate (DnHP). Table 4. Appendix B. 81. Chlorine gas. Table 4. Appendix B. 67. Jouni J, Jaakkola J, Ieromnimon A, Jaakkola M. Interior surface 82. Planning Scenarios. Executive Summaries. Created for Use materials and asthma in adults: a population-based incidence in National, Federal, State, and Local Homeland Security case-control study. Am. J. Epidemiology. 2006;164(8):742- Preparedness Activities. Global Secruity.org. 2004. http://www. 749. http://aje.oxfordjournals.org/cgi/content/full/164/8/742. globalsecurity.org/security/library/report/2004/hsc-planning- Accessed April 13, 2009. scenarios-jul04.htm. Accessed April 13, 2009.; Karasik T., 68. Bornehag CG, Sundrell J, Weschler C, et al. The association Toxic Warfare. Rand Corporation; 2002. Various governmental between asthma and allergic symptoms in children and agencies including the government of Washington, D.C. have phthalates in house dust: a nested case-control study. issued legislation to reduce exposure to vulnerable chlorine Environmental. Health Perspectives. 2004; 112(14):1393-1397. in transit (Terrorism Prevention in Hazardous Materials http://www.ehponline.org/members/2004/7187/7187.pdf. Transportation Act of 2005) and legislation is in Congress Accessed April 13, 2009.. (Corzine/Boxer). 69. Kolarik B, Naydenov K, Larsson M, Bornehag C-G, Sundell 83. Ethylene dichloride. Table 4. Appendix B. J. The association between phthalates in dust and allergic 84. Vinyl chloride. Table 4. Appendix B. diseases among Bulgarian children. Environmental. Health Perspectives, 2008; 116(1):98-103. http://www.ehponline.org/ 85. 1,1,1-Trichloroethane. Table 4. Appendix B. members/2007/10498/10498.pdf. Accessed April 13, 2009. 86. Zinc and acrylic acid. Table 4. Appendix B. 70. Jaakkola J, Knight T. The role of exposure to phthalates from 87. Vinyl acetate. Table 4. Appendix B. polyvinyl chloride products in the development of asthma and 88. Lead. Table 4. Appendix B. allergies: a systematic review and meta-analysis. Environmental. Health Perspectives, 2008; 116(7):845-853. http://www.

48 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 89. Toxics Release Inventory (TRI): EnviroFacts. U.S. EPA. 103. Benzo(g,h,I)perylene. Table 4. Appendix B. http://oaspub.epa.gov/enviro/tris_control.tris_print?tris_ 104. Polycyclic aromatic compounds. Table 4. Appendix B. id=90280RMSTR5037P. 2006. Accessed April 13, 2009. 105. Chlorinated paraffins and DecaBDE. Table 4. Appendix B. 90. PolyFloor. LEED Environmental Information Brochure. Gerbert Ltd. http://www.gerbertltd.com/documents/Polyflor_ 106. Styrene. Table 4. Appendix B. LEED_environmental_information.pdf. Accessed April 13, 107. Health Consultation. Mercury Exposures From 3m Tartan 2009. Gerbert’s PolyFlor claims 25% recycled content, but it is Brand Floors. Westerville Schools, Westerville, Franklin 94% post industrial content, apparently mostly from their own County, Ohio. U.S. DHHS Agency for Toxic Substances and processes. The post consumer waste is from food packaging; Disease Registry (ATSDR). http://www.atsdr.cdc.gov/HAC/ Lonseal Green Brochure. Lonseal. http://www.lonseal.com/pdf/ PHA/westerville/wes_p1.html; 2002. Accessed April 13, 2009. GREENbrochure-Lonseal012005.pdf. Accessed April 13, 2009. 108. TRI reports from American Synthetic Rubber in Louisville, Most of Lonseals’s products contain 20% recycled content and KY, U.S. EPA; 2006. http://www.epa.gov/cgi-bin/broker?TRI= the LonEco series contains 50% recycled content but much of 40216MRCNS4500C&YEAR=2004&VIEW=TRFA&TRILI it is from its own operation and all from post industrial sources. B=TRIQ0&sort=_VIEW_&sort_fmt=1&_SERVICE=oiaa&_ Sustainability Information. StaticWorxhttp://www.staticworx. PROGRAM=xp_tri.sasmacr.tristart.macro. Accessed April 13, com/esd-flooring/ameriworx-esd-tile-environmental-info. 2009. php. Accessed March 2, 2009. StaticWorx claims to be the only conductive or static dissipative tile with recycled content, 109. U.S. EPA Toxics Release Inventory facility information but its 10% is entirely post industrial with no indication as to for 2006. U.S. Environmental Protection Agency. whether any of it is from anywhere but there own processes. http://oaspub.epa.gov/enviro/fii_master.fii_retrieve?fac_ search=primary_name&fac_value=&fac_search_ 91. Municipal Solid Waste in The United States: 1999 Facts type=Beginning+With&postal_code=&location_ and Figures, Table 7. Plastics In Products in MSW. U.S. address=&add_search_type=Beginning+With&city_ Environmental Protection Agency. July 2001. http://epa.gov/ name=&county_name=&state_code=&epa_region_ osw/nonhaz/municipal/pubs/msw99.pdf code=&sic_code=&all_programs=NO&sic_code_ 92. Principia Partners. Post Industrial and Post Consumer Vinyl desc=&naics_code=&all_programs_naics=NO&naics_code_ Reclaim. Report to the Chlor Vinyl Steering Group of the desc=&chem_name=&chem_search=Beginning+With&cas_ Vinyl Institute. 1999. http://www.vinylinfo.org/Recycling/ num=000106990&program_search=2&page_no=1&output_ VinylRecyclingReport.aspx. Accessed April 13, 2009. sql_switch=TRUE&report=1&database_type=TRIS. Accessed 93. Design for Recyclability Guidelines – PVC Bottles, July 18, 2008. 2006 atmospheric releases by industrial sector Association of Post Consumer Plastic Recyclers, http:// include: Petrochemical Refining (669,662 pounds), Styrene- www.plasticsrecycling.org/technical_resources/design_for_ Butadiene rubber manufacturing (167,984 pounds), other recyclability_guidelines/pvc_bottles.asp Accessed October synthetic rubber manufacturing (83,274 pounds), Basic Organic 20, 2007; Association of Post Consumer Plastic Recyclers Chemicals Manufacturing (368,163), Plastics Material and (APR) takes a stand on PVC. Press release. Association of Post Resins Manufacturing (134,657), and other (45,322). Consumer Plastic Recyclers. April 14, 1998. See also, http:// 110. 2006 combined TRI releases. U.S. EPA Toxic Release www.plasticsrecycling.org/technical_resources/design_for_ Inventory http://www.epa.gov/enviro/html/tris, accessed recyclability_guidelines/pvc_bottles.asp. Accessed April 13, 9/5/2008 TRI releases (pounds) for the 7 SBR manufacturing 2009. plants were: n-hexane 2,611,932, styrene 762,516, 94. About Resilient Flooring – History. Resilient Floor Covering cyclohexane 183,356, 1-3-Butadiene 133,058, ammonia Institute. http://www.rfci.com/int_ARF-History.htm. Accessed 82,077, ethylbenzene 46,001, nitrate compounds 31,655, February 22, 2009. dicyclopentadiene19,688, hydrochloric acid 16,900, acetonitrile 6,114, Certain Glycol Ethers 5,503, Lead 4,849, 95. Fenichell S. Plastic: The Making of a Synthetic Century. Harper acrylonitrile 3,818, hydrogen fluoride 2,237, sodium nitrite Business;1996. 1,722, chlorine 1,620, allyl alcohol 1,128, polycyclic aromatic 96. Joseph Salamone, Polymeric Materials Encyclopedia (CRC Press, compounds 437, mercury 40, benzo(g,h,I)perylene 12, for a 1996), p. 167 total 3,914,663 pounds. The 7 plants are: American Synthetic 97. Synthetic Rubber. Wikipedia, http://en.wikipedia.org/wiki/ Rubber, Louisville, KY, TRI ID40216MRCNS4500C; Synthetic_rubber#Table_of_common_synthetic rubbers. Firestone, Lake Charles (Sulphur), LA Accessed September 14, 2008. Synthetic rubber makes up 70% TRI ID 70602FRSTNLA108; Firestone, Orange, TX, TRI of current total rubber use and SBR accounts for over 25% ID 77630FRSTNFARMR; Goodyear, Beaumont, TX, RI of all synthetic rubbers (including both latex and non-latex ID 77720THGDYINTER; Goodyear, Houston, TX, TRI ID SBR); United States Census Bureau. Economic Census, 2002. 73505GDYRT1GOOD; ISP Elastomers, Port Neches, TX, TRI http://www.census.gov/econ/census02/data/industry/E325212. ID 77651SPSYN1615M; Lion Copolymer, Baton Rouge, LA, HTM#T4. Accessed September 14, 2008. TRI ID 70821CPLYM5955S. 98. Rubber FAQs. Rubber Manufacturing Association. http://www. 111. 1,3 Butadiene. Scorecard. www.scorecard.org/chemical- rma.org/about_rma/rubber_faqs/index.cfm. Accessed September profiles/html/13butadiene.html. Accessed September 9, 2008. 14, 2008. Environmental effects are primarily local and immediate as 99. Styrene-butadiene Rubber (SBR) Uses and Outlook. ICIS. 1,3, butadiene breaks down quickly in air via sunlight and com. http://www.icis.com/v2/chemicals/9076467/styrene- evaporates easily from water and soil. While atmospheric life butadiene-rubber/uses.html. Accessed on July 3, 2008. of 1,3-butadiene is short, some of the breakdown products are problematic as well, including formaldehyde, a known 100. 2006 Toxics Release Inventory (TRI) Public Data Release carcinogen.(1,3-butadiene Formaldehyde also has a short half Brochure., U.S. Environmental Protection Agency (U.S.EPA). life in air of 1-19 hours, but can be somewhat more persistent http://www.epa.gov/tri/tridata/tri06/brochure/brochure. in water with a half life of up to ten days. htm#others. Accessed April 13, 2009. 112. 1,3, butadiene. Table 4. Appendix B. 101. Lead. Table 4. Appendix B. 102. Mercury. Table 4. Appendix B.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 49 113. Clapp R, Jacobs M, Loechler E. Environmental and Rubber Sheet & Tile fact sheet, Environmental Works, 2002, Occupational Causes of Cancer: New Evidence, 2005-2007. http://www.eworks.org/pdfs/RubberFacts.pdf Lowell Center for Sustainable Production. University of 130. Tire-Derived Resilient Floor Study. Sustainable (Green) Massachusetts Lowell;2007 citing Cheng H, Sathiakumar N, Building. California Integrated Waste Management Board, Graff J, Matthews R, Delzell E. 1,3-Butadiene and leukemia 2007. http://www.ciwmb.ca.gov/GreenBuilding/Materials/ among synthetic rubber industry workers: exposure-response Research/TireStudy.htm. Accessed April 13, 2009. relationships, Chemico-Biological Interactions. 2007; 166(1- 3):15-24. http://www.tera.org/peer/TCEQ/TCEQ%201,3%20 131. See, for example, the new Au-Natural 100% natural rubber Butadiene/TCEQ%20Butadiene%20CD%20files/Cheng%20 flooring. Allstate Rubber. http://www.muchocolors.com/. et%20al.%202007_06002900.pdf. Accessed April 13, 2009. 132. Rivzi H. LIBERIA: Firestone Sued Over “Slave” Plantation. 114. Toxicological Profile for 1,3-Butadiene.Agency for Toxic CorpWatch 2005. http://www.corpwatch.org/article. Substances and Disease Registry. Public Health Service; 1993. php?id=12860. Accessed April 13, 2009; http://www.atsdr.cdc.gov/toxprofiles/tp28.html. Accessed April Parks J. $3 Million for Super Bowl Ad. $3 for Workers 13, 2009. Who Paid For It. AFLCIO NOW blog. http://blog.aflcio. 115. Draft Toxicological Profile. Agency for Toxic Substances and org/2009/02/01/3-million-for-super-bowl-ad-3-for-workers- Disease Registry, Public Health Service; 2007. http://www. who-paid-for-it/. Accessed April 13, 2009; and Murray R. atsdr.cdc.gov/toxprofiles/tp53-c5.pdf. Accessed April 13, 2009. We Will Use Our Children as Shields. Global Intelligence Styrene can be found in air, soil, and water after release from News. December 2008. http://globalintel.net/wp/2008/12/10/ the manufacture, use and disposal of styrene-based products; rights-liberia-%E2%80%98we-will-use-our-children-as- Public Health Statement – Styrene . ATSDR; 2007. http:// shields%E2%80%99/. Accessed April 13, 2009. www.atsdr.cdc.gov/toxprofiles/phs53.html . Accessed April 13, 133. Specifications & Environmental Information: To Market 2009. Like 1.3 butadiene, styrene has a relatively short half life, Atmosphere Recycled Rubber Flooring. http://www.tomkt.com/ photodegrading in the atmosphere with half life of 7-16 hours atmosphere/pdf/Atmosphere_3.pdf . Accessed April 13, 2009. and biodegrading in most top soils and aquatic environments. To Market is one manufacturer who takes back product at Bioconcentration does not appear to be significant. the end of its life. It is not clear whether it is recycled back to 116. Styrene. Table 4. Appendix B. flooring or to other uses. 117. Acrylonitrile. Table 4. Appendix B. 134. Wastes – Resource Conservation – Common Wastes & Materials – Scrap Tires: Tire-Derived Fuel, U.S. EPA, http:// 118. Ethylbenzene. Table 4. Appendix B. www.epa.gov/wastes/conserve/materials/tires/tdf.htm . Accessed 119. Benzene. Table 4. Appendix B. April 20, 2009. 120. Acute toxicants emitted by U.S. SBR producers include: 135. Recyclable Materials: Scrap Tires. Recycling Council of n-hexane, cyclohexane, ammonia, hydrochloric acid, sodium Ontario. http://www.p2pays.org/ref/11/10504/html/biblio/ nitrite, nitrate compounds, dicyclopentadiene, acetonitrile, htmls2/cgh3.html . Accessed April 13, 2009. glycol ethers, hydrogen fluoride, chlorine, allyl alcohol. 136. Chloroform (CAS 67-66-3) is listed as a known, likely or 121. Casarett and Doull. Toxicology. 5th ed. McGraw-Hill; New probable carcinogen by NTP ROC, CA Prop65, EPA IRIS, York; 1996. and see Dithiocarbamates in table 4 Appendix B likely neurotoxicant (Lancet). 122. Morrow N. The industrial production and use of 1,3-butadiene. 137. Methylene chloride (CAS 75-09-2) is listed as a known Environmental. Health Perspectives 1990; 86:7-8. http://www. probable or likely carcinogen by CA Prop65 EPA IRIS and ehponline.org/members/1990/086/86002.PDF. Accessed April NTP ROC and a possible carcinogen by IARC and EC Risk. 13, 2009. 138. Amtico Stratica brochure. Amtico. http://www.amtico.com/ 123. Dimethylformamide. Table 4. Appendix B. main/cms/includes/asp/CMFileGetFile.asp?fi=1805. Acessed 124. Rubber Sheet & Tile fact sheet. Environmental Works. 2002. April 13, 2009. http://www.eworks.org/pdfs/RubberFacts.pdf. Accessed April 139. Amtico appears to do most of the manufacturing of Stratica at 13, 2009. plants in England. We have not been able to obtain emissions 125. Broadhurst M. Recycled Content, Renewable Raw Materials data from those facilities. There are two Amtico facilities in the No Longer Strangers to Resilient Floor Coverings. National U.S., but they are small, do not report TRI data, and one holds Floor Trends/Flooring Insider. 2004. http://www.ntlfloortrends. an EPA exemption as a “conditionally exempt small generator.” com/Articles/Feature_Article/82f5128d701b7010VgnVCM100 Amtico International, Georgia Facts.net, http://www.gafacts. 000f932a8c0. Accessed April 13, 2009. com/net/content/go.aspx?noredirect=1&s=107484.0.5.3013. Accessed April 20, 2009, Envirofacts Data Warehouse, U.S. 126. Examples include Re-Tire and cor-Terra from Capri Cork, EPA, http://oaspub.epa.gov/enviro/multisys2.get_list?facility_ Ceres natural Floors and Expanko Reztec uin=110012225065. Accessed April 20, 2009. We expect that 127. TRC, A Review of the Potential Health and Safety Risks from only minor cutting and finishing work is done at these plants. Synthetic Turf Fields Containing Crumb Rubber Infill. New York 140. Arkema is the current name of the merged TotalFina and Elf City Department of Health and Mental Hygiene. 2008. http:// Groups, which manufactures Lotyrl resins, including the 18 www.nyc.gov/html/doh/downloads/pdf/eode/turf_report_05-08. MA 02 resin. Arkema’s MSDS lists the composition of Lotryl pdf. Accessed April 13, 2009. 18 MA 02 resin as >99% 2-propenoic acid, methyl ester, 128. CHPS list of low emitting materials. http://www.chps.net/ polymer with ethane (CAS: 25103-74-6). http://www.arkema- manual/lem_table.htm. Accessed April 13, 2009. CERES inc.com/msds/1071.pdf. Accessed April 13, 2009. Recycled Rubber Flooring and ECOSurfaces’ ECOnights, 141. POPs Review Committee (POPRC) Dossier Annex. Swedish ECOearth, ECOrocks, ECOsand, and ECOstone are on the Chemicals Inspectorate (KemI) and the Swedish EPA. One of CHPS list. 96 chemicals that may degrade to perfluorooctane sulphonate 129. Alevantis L. Building Material Emissions Study. California (PFOS) in the environment. http://www.eiatrack.org/docs/ Integrated Waste Management Board. http://www.ciwmb. swe_PFOS_Dossier.pdf. Accessed April 13, 2009. See PFOS ca.gov/GreenBuilding/specs/Section01350/METStudy.htm. Table 4 Appendix B 2003. Accessed April 13, 2009. 142. Zinc. Table 4. Appendix B.

50 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 143. Formaldehyde. Table 4. Appendix B. 152. Trifluran. Table 4. Appendix B. See also First List of pesticides 144. Methacrylic acid. Table 4. Appendix B. for U.S. EPA’s Endocrine Disruptor Screening Program Fluoride Action Network Pesticide Project, http://www.fluoridealert.org/ 145. International Agency for Research on Cancer (IARC) – pesticides/endocrine.epa.2007.html. Summaries & Evaluations: Ethylene (Group 3) 1994; 60: 45. http://www.inchem.org/documents/iarc/vol60/m60-01.html. 153. Trifluran. Ibid. Accessed April 13, 2009. 154. Knudsen HN, Clausen PA, Wilkins CK, Wilkoff P. Sensory 146. Walker. Op, cit. and Törnqvist MA. Is ambient ethene a cancer and chemical evaluation of odorous emissions from building risk factor? Op. cit. products with and without linseed oil. Build. Environ. 2007; 42(12): 4059-4067. http://dx.doi.org/10.1016/j. Törnqvist MA. Ethylene oxide doses in ethane-exposed fruit buildenv.2006.05.009. Accessed April 13, 2009. store workers. Op. cit. Csanady, GA, et. al, A Physiological Toxicokinetic model for exogenous and endogenous ethylene 155. Sustainable (Green) Building, Building Material Emissions and ethylene oxide in rat, mouse, and human: formation of Study (BMES). Op. cit. 2-hydroxyethyl adducts with hemoglobin and DNA. Toxicology. 156. Acetaldehyde. Table 4. Appendix B. Appl. Pharmacology.. 2000; 165 (1):1-26. http://www. 157. Knudsen HN. Op. cit. sciencedirect.com/science?_ob=ArticleURL&_udi=B6WXH- 45BCDKK-4V&_user=10&_rdoc=1&_fmt=&_orig=search&_ 158. Work with Manufacturers to Reformulate Products. sort=d&view=c&_acct=C000050221&_version=1&_ Sustainable Green Building. Op. cit. http://www.ciwmb.ca.gov/ urlVersion=0&_userid=10&md5=ba5b58d71cd0856950a28b9e GreenBuilding/specs/Section01350/METStudy.htm#Update. 63216ad4 (abstract only). Accessed April 13, 2009. Accessed February 22, 2009. 147. Ethylene oxide. Table 4. Appendix B. See also Törnqvist M, 159. Asbestos. Table 4. Appendix B. Op. Cit. 160. Home Safety – Asbestos. Center for Environmental Health, 148. Granath F. Op. cit. University of Connecticut. http://ceh.uconn.edu/asbestos.html. Accessed April 13, 2009. 149. Grandjean P, Landrigan P. Developmental neurotoxicity of industrial chemicals. The Lancet, 2006; 368(955)2167-2178. 161. Glogoza P, McMullen M, Zollinger R., Pesticide Use and Pest http://www.reach-compliance.eu/english/documents/studies/ Management Practices for Major Crops in North Dakota neurotoxity/PGrandjean-PjLandrigan.pdf. Accessed April 13, – 2000. North Dakota State University Extension Service. 2009. http://www.ag.ndsu.nodak.edu/aginfo/entomology/nd_pmc/ Major_Crops_02/Use_FLAX.pdf. Accessed April 13. 2009. 150. Ackerman F, Massey R. The Economics of Phasing Other toxic pesticides used on flax include Sethoxydim CAS# Out PVC, Global Development and Environment 74051-80-2, MCPA 2-Methyl-4-Chlorophenoxyacetic Acid Institute, Tufts University. December 2003. http://ase. CAS # 94-74-6 Glyphosate (Roundup) CAS # 1071-83-6. tufts.edu/gdae/policy_research/healthEnvironment.html. Accessed April 13, 2009; Fisher B. Floorward Thinking. 162. Trifluran. Table 4. Appendix B. Environmental. Health Perspectives, 1999;107(7):A362-A364. 163. Brown A. Pesticides and Cancer. Maryland Cooperative http://www.pubmedcentral.nih.gov/picrender. Extension http://www.entmclasses.umd.edu/peap/leaflets/PIL33. fcgi?artid=1566677&blobtype=pdf . Accessed April 13, 2009. pdf. Accessed April 14, 2009. 151. Manufacturing information was drawn from the following 164. Mancozeb. Table 4. Appendix B. sources: 165. Bromoxynil. Table 4. Appendix B. Sanz, C, Linoleum makes a comeback and proves it’s not what 166. Trichlorfon. Table 4. Appendix B. you think, http://blackriverfloors.com/category29/Linoleum- Planks/ , Accessed February 3, 2009. 167. Benzene. Table 4. Appendix B. “Forbo Linoleum, Inc.; Marmoleum: from production to end 168. Maleic anhydride. CAS 108-31-6Technology Transfer of life production. Environmental Design & Construction. Network, Emissions Factors & AP 42. U.S. EPA. http://www. January 1, 2004. epa.gov/ttn/chief/ap42/ 1983, 1995. Case Study – Replacement of Benzene with N-Butane in the production of Maleic Natural Raw Materials, Tilo GMBH, http://www.tilo.com/e_ anhydride, North Carolina Division of Pollution Prevention home.htm?vorbild/e_werklinoleum.htm , Accessed February 3, and Environmental Assistance, 1992 http://www.p2pays.org/ 2009. ref/10/09299.htm .. An unreferenced Wikipedia article (Maleic Tarkett – Linoleum XF [BLP]] Products page, Ecospecifier anhydride http://en.wikipedia.org/wiki/Maleic_anhydride (http://www.ecospecifier.org/products/public/tarkett_linoleum_ accessed 2/20/2009) reports that as of 2006 only a few smaller xf_blp . Accessed February 3, 2009. plants continue to use benzene. N-Butane is not without its Gorree, M., Environmental Life Cycle Assessment of problems. Chronic exposure to n-butane has been reported to Linoleum, (commissioned by Forbo), Centre of Environmental cause some symptoms in the central nervous system. Butane, Science – Leiden University (CML-UL). June 2000, http:// Hazardous Substances Data Bank (HSDB) http://toxnet.nlm. www.leidenuniv.nl/cml/ssp/publications/lcalinoleum.pdf nih.gov/cgi-bin/sis/search/f?./temp/~r9cPr2:1 . Accessed April Accessed February 3, 2009. 20, 2009. “Industry Profile: Chemical Works: linoleum, vinyl and 169. Pentaerythritol (CAS# 115-77-5). In Wittcoff HA, Reuben bitumen based floor covering manufacturing works” British BG, Plotkin JS. Industrial Organic Chemicals., Wiley Press. 2004. Department of the Environment, 1995 http://publications. 170. Acetaldehyde and formaldehyde. Table 4. Appendix B. environment-agency.gov.uk/pdf/SCHO0195BJKF-e-e. 171. NIIR Board Staff. Modern Technology of Oils, Fats and its pdf?lang=_e . Accessed February 3, 2009. Derivatives. National Institute of Industrial Research, New Laumer, J., Armstrong Brings Back Linoleum, Renewing a 140 Delhi, 2000:181. Year old Tradition 172. Epichlorohydrin. Table 4. Appendix B. TreeHugger, May 4, 2005 http://www.treehugger.com/ files/2005/05/armstrong_bring_1.php Accessed February 3, 2009.

Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care 51 173. Sustain 2008 brochure – Creating better environments Estimating Releases and Prioritizing Sources in the Context of Forbo; 2008. http://www.themarmoleumstore.com/default. the Stockholm Convention. International POPs Elimination aspx?menuid=549. Accessed April 13, 2009. Network, Mexico, 2005; 174. Forbo, Ibid. Costner P., Update of Dioxin Emission Factors for Forest Fires, 175. For more discussion of the challenges of LCAs, See Lent Grassland and Moor Fires, Open Burning of Agricultural T, Toxic Data Bias and the Challenges of Using LCA in Residues, Open Burning of Domestic Waste, Landfills and the Design Community. Proceedings of GreenBuild 2003 Dump Fires. conference. U.S. Green Building Council, 2003. http:// International POPs Elimination Network. 2006. http://www. www.healthybuilding.net/pvc/Toxic_Data_Bias_2003.html. ipen.org/ipenweb/documents/work%20documents/dioxin%20 Accessed April 13, 2009. fires%20costner.pdf 176. Altschuler K. Horst S, Malin N, Norris G, Nishioka 188. Stratica Patent: Hawood, etc., Amtico Company, “Floor Y. Assessment of the technical basis for a PVC related coverings” United States Patent PCT/GB94/02035, published materials credit for LEED. U.S. Green Building Council March 30, 1995; U.S. Patent No. 5,728,476, published March (USGBC);February 2007. http://www.usgbc.org/DisplayPage. 17, 1998. http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PT aspx?CMSPageID=1633. Accessed April 13, 2009. O2&Sect2=HITOFF&p=1&u=%2Fnetahtml%2FPTO%2Fsea 177. BEES (Building for Environmental and Economic rch-bool.html&r=6&f=G&l=50&co1=AND&d=PTXT&s1=a Sustainability software, U.S. Department of Commerce, mtico.ASNM.&OS=AN/amtico&RS=AN/amtico National Institute of Standards and Technology (NIST). http:// Stratica Patent: Harwood, et al., The Amtico Company www.bfrl.nist.gov/oae/software/bees. Accessed April 13, 2009. Limited, “Floor Coverings,” U.S. Patent No. 6,007,892, filed 178. Lent, Ibid. Nov. 21, 1996, published Dec. 28, 1999. 179. A New Chlorine-Free Competitor to Vinyl Flooring. Stratica Patent: Ivor C. Harwood, et al., The Amtico Company Environmental Building News. 1998. Limited, “Floor Coverings,” U.S. Patent No. 6,103,044, filed January 23, 1998, dated August 15, 2000. http://patft.uspto. http://www.buildinggreen.com/auth/article.cfm/1998/10/1/A- gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&p=1 New-Chlorine-Free-Competitor-to-Vinyl-Flooring/ . Accessed &u=%2Fnetahtml%2FPTO%2Fsearch-bool.html&r=2&f=G April 13, 2009. &l=50&co1=AND&d=PTXT&s1=amtico.ASNM.&OS=AN/ 180. Gunther A, Langowski H. Life cycle assessment study on amtico&RS=AN/amtico resilient floor coverings. 189. Deklarationsinformation, Deklaration för varunr: 202827 Int. J. LCA, 1997;2(2):73 – 80. http://www.springerlink.com/ Svenskbyggtjanst, 2005-03-15, http://www.amtico.se/amtico/ content/u31n85m3h25n411w/ (reference only). Accessed dokument/stratica%20byggvarudeklaration.pdf . Accessed April 13, 2009. April 20, 2009. 181. Hodgson A, Fisk W, Shendell D, Apte M. Predicted 190. Information also gained from A New Chlorine-Free concentrations in new relocatable classrooms of volatile Competitor to Vinyl Flooring, Environmental Building News, organic compounds emitted from standard and alternate Oct. 1, 1998, at: http://www.buildinggreen.com/auth/article. interior finish materials. Environmental Energy Technologies cfm/1998/10/1/A-New-Chlorine-Free-Competitor-to-Vinyl- Division, E.O. Lawrence Berkeley National Laboratory; 2001 Flooring Report No. LBNL-48490. 191. MSDS for Lotryl 18 MA 02, Arkema http://www.arkema-inc. 182. An Inventory of Sources and Environmental Releases of com/msds/1071.pdf. Accessed April 20, 2009. Dioxin-Like Compounds in the United States for the Years 192. DuPont Surlyn 9910 technical data sheet, March 2004, Doc. 1987, 1995, and 2000. U.S. EPA November 2006. http:// Ref. z7xx2r3d.pdf http://www2.dupont.com/Surlyn/en_US/ cfpub.epa.gov/ncea/cfm/recordisplay.cfm?deid=159286. assets/downloads/surlyn_9910.pdf. Accessed April 20, 2009.; Accessed April 13, 2009. DuPont Surlyn 9910 MSDS http://msds.dupont.com/msds/ 183. 2000 Dioxin Data from Major Chlorine Producers and Users, pdfs/EN/PEN_09004a2f800063d9.pdf. Accessed April 20, Dioxin Data: Disposal of Dioxin to Underground Injection 2009.; Surlyn webpage of Mauritz Research Group, School Wells and Landfills. Chlorine Chemistry Division of the of Polymers and High Performance Materials, University of American Chemistry Council. http://www.dioxinfacts.org/ Southern Mississippi, http://www.psrc.usm.edu/mauritz/surlyn. tri_dioxin_data/2002_dioxin_data/land_2002.html . Accessed html . Accessed April 20, 2009. April 20, 2009. 193. MSDS for Lotader 4700 Arkema, http://www.arkema-inc.com/ 184. 2000 Dioxin Data from Major Chlorine Producers and msds/1086.pdf. Accessed April 20, 2009. Users, Dioxin Data: Transfers to Off-site Locations. Chlorine Chemistry Division of the American Chemistry Council . http://www.dioxinfacts.org/tri_dioxin_data/2002_dioxin_data/ transfers_2002.html . . Accessed April 20, 2009. . 185. 2000 Dioxin Data from Major Chlorine Producers and Users, Dioxin Data: Source Reduction Activities, Chlorine Chemistry Division of the American Chemistry Council is http://www. dioxinfacts.org/tri_dioxin_data/2002_dioxin_data/source_2002. html. Accessed April 20, 2009. 186. Costner P. Estimating Releases and Prioritizing Sources in the Context of the Stockholm Convention. International POPs Elimination Network, Mexico, 2005. http://www.ipen.org/ ipepweb1/library/ipep_pdf_reports/7mex%20estimating%20 dioxin%20releases%20english.pdf. Accessed April 13, 2009. 187. Costner P. Dioxin Emission Factors for Forest Fires, Grassland and Moor Fires, Open Burning of Agricultural Residues, Open Burning of Domestic Waste, Landfill and Dump Fires:

52 Resilient Flooring & Chemical Hazards: A Comparative Analysis of Vinyl and Other Alternatives for Health Care

Health Care Without Harm 1901 N. Moore Street, Suite 509 Arlington, VA 22209 www.noharm.org

Global Health and Safety Initiative 5957 Chabot Crest Oakland, CA 94618 www.globalhealthsafety.org

Healthy Building Network 927 15th Street, NW, 4th Floor Washington, DC 20005 www.healthybuilding.net